Moreover, the group is urging its physician members to evaluate the potential for ACOs for physician groups to set up their own practices within them. Goertz acknowledges, however, the AAFP leadership is extremely "cautious" because of anti-trust regulations. The ACCFP membership includes 65,000 family physicians, roughly 84% of all family practioners in the country. About half its members are in small or medium-size practices.
"We are very keen in trying to urge physicians to set themselves up to form ACOs, so that the only ACO model is not driven by hospitals; not that that's bad, but we think should be; urging our members consider in a regionalized way forming either IPAs (independent practice association) or optional formats that the rules would allow," Goertz says. "Physician groups might structure themselves to also be an ACO. We hope that indeed happens.
"We do believe and we have said a strong primary care basis is going to be very important for an ACO to function," he says. "The patient-centered medical home in the neighborhood of other specialists and other elements of healthcare delivery is one of the only models of healthcare reformation that offers an option with provable demonstration projects that bend the cost curve while maintaining quality and good patient care."
As the academy sees it, however, solo and small practioners not only enable participation in the ACOs, but also have the option for an "opt out," Goertz says.
"We had some real concerns about how the rules would be written in restricting participation of solo practioners or small group practices within an ACO," Goertz says. "It appears the use rules do allow participation, and indeed, do allow an opt-out, if indeed a practice decides they'd just rather stay traditional. How long that would be allowed, I'm not sure. That's part of some of the questions that we will ask."
"The other thing that we had concerns about, and will continue to have concerns [about]– but appears to be addressed, [is that] there is a required physician-directed quality assurance and improvement process built within any proposed AMO format. Embedded within that set of rules is a 75% ACO leadership or governance being represented by clinical or administrative physicians," Goertz said. "We think a lot of physician organizations were concerned that this ACO formation might be viewed by less healthcare oriented businesses as an opportunity for less healthcare minded entities to get into the fray, to set up governances and structures that weren't necessarily going to be patient-focused and care-driven. We are pleased with those aspects.