Medicare hopes to use the accountable care organization (ACO) to coordinate care so that quality is improved and costs are lowered, but new research suggests that the design of the ACO may need to pay special attention to physicians (Source: “Inspecting the role of the physician in ACOs,” Modern Healthcare, April 4, 2017).
A study published Monday in Health Affairs noted significant physician churn from year to year, as well as an uneven distribution of patients among physicians in one Medicare Pioneer ACO. The results raised questions about the structure of ACOs—a payment model touted by many and supported by the CMS—and their ability to achieve the goals of lowering costs while improving quality.
“Physicians really are the crux of the ACO itself,” said Dr. John Hsu, the lead author of the study and the director of the clinical economics and policy analysis program at the Mongan Institute of Massachusetts General Hospital in Boston. “It's really important to look to see how things are actually working, and what are the areas of concern and how we might be able to anticipate potential problems that could arise downstream and head them off."
Hsu and his co-authors found that the sickest and most expensive beneficiaries were concentrated among a minority of physicians, while the majority of physicians saw ACO beneficiaries with modest costs. This distribution could, theoretically, give ACOs the opportunity to cherry-pick patients by selecting only certain physicians each year. It was, the authors wrote, “a relatively simple mechanism to 'game' the risk pool.”