SAN FRANCISCO -- The number of physician-led accountable care organizations (ACOs) has recently surpassed the number led by hospitals, becoming the largest backers of the payment and delivery model, an analysis showed.
Last March, hospital-led ACOs outnumbered those headed by doctors nearly two to one (91 to 45), said Neil Kirschner, PhD, ACP senior associate of regulatory and insurer affairs.
But after the Centers for Medicare and Medicaid Services (CMS) approved a new batch of ACOs earlier this year, physician-led organizations outpaced their hospital counterparts (202 to 189), he reported at the American College of Physicians annual meeting.
ACOs are a fairly recent payment and delivery model in which a group of providers works in collaboration to deliver high quality, low-cost care to a defined group of patients. In the increasingly popular shared-savings model offered by CMS, ACOs have split up to half of the savings they generated the prior year. It's a dollar amount that's dependent on hitting quality measures.
Physicians stand to gain additional revenue in the models when they treat more patients in their offices rather than visiting them in the hospital, which is a primary goal of ACOs, experts here said.
"For hospitals, it's a bit of a conundrum. The way to save money in an ACO largely consists of decreasing hospital admissions and [emergency department] visits, which are hospital-based services," said Kenneth Wilkins, MD, president of Coastal Carolina Health Care in New Bern, N.C. "They get paid very well for these services. They stand to lose some revenue."
Wilkins helped form a doctor-led ACO last year with more than 50 physicians. There is no hospital involved in the organization, just an urgent care center, imaging lab, and sleep center.
Physician-led ACOs are generally smaller in size, serving on average about half the number of patients as hospital-backed systems. Unlike hospitals, doctor organizations can pool together numerous small practices to have enough patients.
Overall, there were 146 ACOs at this time last year; there are now 428, according to the health consulting firm Leavitt Partners of Salt Lake City.
There are also nearly as many ACOs supported through private payers (176) as there are supported by Medicare (203), according to analyst David Muhlestein.
"While ACO growth will undoubtedly continue for at least the immediate future, it still represents a small minority of care delivered in the U.S.," . "Whether the numerous organizations that are cautiously observing ACOs from the side will ever take the plunge and adopt accountable care models will largely depend on the success of these early adopters."
Kirschner said an estimated 15% of patients are impacted by an ACO, even if they aren't one of the patients an organization figures into its savings. Nearly 80% of Hospital Referral Regions have at least one ACO.
This is more than just a passing fad, Wilkins said, although not all doctors are convinced of the benefits of the ACO model.
"I think the way physicians see it depends a little bit on the age of the physician," Wilkins said. "I think for younger folks ... it's not as big a change for them."
Wilkins offered a number of tips for physicians looking to start their own ACO:
- Study Medicare costs for your service area to see how well you can lower costs
- Develop processes to promote evidence-based medicine
- Focus on patient satisfaction because it accounts for a quarter of ACO's quality measures
- Establish appropriate incentives for providers in the group
- Develop interventions like a 24-hour nurse hotline, expanded urgent care, and next-day appointments
- Engage patients through annual wellness visits, patient portals, and shared decision-making
Kirschner noted that ACP, the American Medical Association, and others professional groups have been encouraging practices to look into creating ACOs and becoming leaders in delivery reform.
"It gives physician practices a place at the table and [the ability] to help define how medicine is being delivered as opposed to the big elephant in the room -- the hospital -- making those decisions," Kirschner told 51˶.