The Physician's Place in the ACO

Philip Betbeze, for HealthLeaders Media , November 15, 2010
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Dennis Dahlen, CFO at Banner Health in Phoenix, thinks his health system would be in the right position to be that distributor, as it employs much of its physician staff and has active contracting relationships with independent physicians, and is on track to add more to both categories over years.

"The payment reform modeling in the healthcare reform [law] is probably the sugar that makes the medicine go down," he says. "Whether it's bundling or an ACO, it provides a currency to work with physicians and other providers for that coordination. Absent that currency, we actually mostly have barriers to working cooperatively." 

Despite the fact that, in some cases, physicians might not directly control how the bundled payment is distributed among the entities responsible for a patient's care, the physician is going to have to be in a key leadership role, says George Mayzell, MD, MBA, who is chief patient care officer at Methodist Le Bonheur Healthcare, a seven-hospital system in Memphis, TN, which also owns home health centers and a number of outpatient facilities in the area.

"That's the way this will work," he says of the physician's role in the ACO. "Ultimately, they decide the quality of care and the cost through the mighty pen. If it's an IPA of docs who understand it's about the patient and quality and managing that financial risk, why can't they have the money and bring the other players to the table?" he asks. "It's not about who's calling the meeting—you'll see different models of ACOs in different communities," he says, mentioning Geisinger Health System, Summa Health System, and others as ACO leadership.

Mayzell says that taking on risk is one way for physicians to fight back against the perception that they cause overutilization and healthcare cost increases because they don't communicate well with each other. That may be unappealing, but the positive part of taking on risk is that "they'll be in charge. Lots of physicians don't like the resource accountability, but we have to control healthcare resource use," he says.

"Who better than docs? There will be some learning and struggle, but if we're focusing on evidence-based care and measuring that, resources have to be part of that decision-making. Overutilization actually provides worse care. Physicians have got to take this on."

At Methodist, Mayzell says one of the biggest challenges to the success of the ACO is "who gets the pot of money, because that can make or break how well this works."
Locally, he says, Methodist's physician hospital organization will likely be the distributor of payments to the variety of stakeholders involved in the ACO.

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2 comments on "The Physician's Place in the ACO"

John Barbuto, MD (3/11/2011 at 1:00 PM)
You make a statement which is critically flawed. You say patients "are trying to get well". That is certainly true to a large extent. But, it has subtle, critical flaws. First, patients who seek health care are certainly trying to get health care, but they are routinely trying to get the health care they "think" will make them well. They are trying to meet their belief systems - which may or may not be consonant either with optimal care or with achieving health. For example, there is a huge industry of "health care" which is purchased via health food stores or other "complementary and alternative" sources. The vast majority of these services are provided with no rigorous science behind them at all - only claims and anecdote (and maybe some inferential low order studies). In these realms the hypothesis of "evidence-based medicine" is a joke; yet, the services are consumed to the tune of many billions of dollars a year. And, this example only represents a concept which has much greater ramification even than this industry. In addition, a small but critical portion of patients come to the doctor to obtain services which support some secondary agenda - an agenda which may not be served by becoming well. So, for example, auto or industrial accident blame games, unwarranted disability pursuits, escape from responsibility, social control over others, and other "hidden agendas" lead to service which is rendered not to become well but rather to serve the hidden social agenda. This also is big business in some arenas. So, while it is true that most patients seek to become well, the most accurate statement is that patients seek health care to receive health care services - whatever agenda may be underlying the pursuit. We like the hypothesis that medicine proceeds best based on evidence-based science. But, the actual evidence is that this hypothesis is flawed in some important ways.

Gregg Masters (11/16/2010 at 2:08 PM)
Nice piece! We really need to keep the focus on the provider education perspective; via a lens of institutional memory, lest we recreate the same mistakes of the past. The scope and range of concerns, including the many competing voices for visibility in this space require attention on key narrative curation, and vetting of the many threads in this unfolding story!




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