Top 10 Clinical Integration, ACO Physician Questions

Eric Nielsen, MD, and James Smith, MBA, FACHE, The Camden Group, for HealthLeaders Media , June 9, 2011

8. What is the hospital's role in an ACO/CI initiative? Some physicians, notably a high percentage of newly trained physicians, hospital-based specialists, and a significant number of PCPs, are looking to hospitals for employment. Hospital administrators therefore need an employment strategy, if only to retain their referral base by employing physicians who might otherwise seek employment with a competitor. Hospital administrators with a vision of healthcare in the future also see the need to align with their private (independent, voluntary) physicians in ways that allow those physicians to be invested in continually improving quality and efficiency of care delivered by the network of physicians and the entire continuum of care. CI and accountable care development is becoming a necessary strategy for hospitals alongside an employment opportunity for those physicians who desire it. A management services organization to support these practices is yet another strategy. These strategies are market dependent, and the extent to which each can be used will depend upon the needs of the institutions as well as the physicians.

9. Does the organization just want to control my practice? No, the goal of CI/ACO is to deliver high quality patient care and patient satisfaction. There is nothing in the current regulations on CI or in the CMS proposed regulations for ACOs that would interfere with independent providers' operation of their practices. In addition, providers control their CI/ACO by participating on the committees that develop and maintain clinical protocols and govern the clinical and financial functions of the organization.

10. What's in it for me? By actively participating with CI programs and ACOs, physicians will not only be included in contracts with payers that might otherwise exclude them, but will also have the opportunity to participate in the development of protocols for their network of providers as well as the governance of these organizations. They will receive reports and prompts to help manage their individual patients and the populations of patients they serve, supported by care managers with the tools to help patients maintain or return to health. Branding of the organization will help to enlarge their practices and to broaden the populations they care for. Other benefits to be expected would be: being part of a high quality healthcare delivery system, feedback that the physician is doing the right thing (i.e., providing accurate and timely care), and increased satisfaction with one's career choice.

Dr. Nielsen is a Vice President at The Camden Group, a leading national healthcare business advisory firm, and Mr. Smith is a Senior Vice President. They are both based in the New York office.

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