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New Health Affairs Study Compares Experiences of MD-Led and Other ACOs

June 22, 2014
by Mark Hagland
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A new Health Affairs study looks at the challenges and opportunities facing physicians leading ACOs

An important new study has come out in the June 2014 issue of Health Affairs. The article, entitled “First National Survey of ACOs Finds That Physicians Are Playing Strong leadership and Ownership Roles,” has been authored by Carrie H. Colla, Valerie A. Lewis, Stephen M. Shortell, and Elliott S. Fisher.

In that article, the healthcare policy researchers note that they fielded a first national survey of accountable care organizations (ACOs). As they note in the article, “We found that 51 percent of ACOs were physician-led, with another 33 percent jointly led by physicians and hospitals. In 78 percent of ACOs, physicians constituted a majority of the governing board, and physicians owned 40 percent of ACOs. The broad reach of physician leadership” in ACOs, the authors noted, “has important implications for the future evolution of ACOs. It seems likely that the challenge of fundamentally changing care delivery as the country moves away from fee-for-service payment will not be accomplished without strong, effective leadership from physicians.”

The researchers note in their article that “We were broadly inclusive of potential ACOs in our initial population. In all, 292 organizations were deemed possibly eligible and were invited to participate in the survey.” In the end, 173 ACOs completed the full survey. What the researchers found was a number of revelations, some of which might surprise some in the healthcare industry.

Among other noteworthy findings of the survey:

  • Overall, physicians owned the equipment and employed the staff in 40 percent of ACOs
  • Physicians owned 62 percent of physician-led ACOs, compared to 16 percent in all other ACOs
  • Importantly, physicians constituted a majority of the governing boards of 78 percent of all responding AcOs (94 percent of physician-led ACOs and 65 percent of ACOs led jointly by hospitals and physicians)
  • Physician-led ACOs had fewer primary care physicians and specialist clinicians, but included more individual medical groups than other ACOs
  • Among physician-led ACOs, 37 percent consisted solely of physician practices, compared to only 6 percent in ACOs of other leadership types

Interestingly, the researchers found that physician-led ACOs were more likely than other ACOs to be participating in the general Medicare Shared Savings Program, but less likely to be participating in the Pioneer program, which is designed for large organizations prepared to take on financial Risk. In fact, they found that while two-thirds of physician-led ACOs were participating in the Medicare Shared Savings Program, few were taking on downside risk. As it turned out, only 15 percent of physician-led ACOs were participating in the Advance Payment Program, which is part of the MSSP, but provides start-up capital to physician-based and rural providers.

The authors expressed concern over the capability of physician-led ACOs to access the capital needed to become robust; indeed, a quarter of the ACOs surveyed reported finding it “very challenging” to secure sufficient funds to launch an ACO, though that percentage did not change depending on whether an ACO was physician-led or not.

Also of note, physician-led ACOs were as like as other types to report having advanced care management and health IT capabilities; yet fewer than half of all ACOs had those advanced capabilities. The researchers found that physician-led ACOs are leading in outpatient care management and health IT, but are lagging in their ability to manage across care settings (transitions and readmissions).

Importantly, the authors note, “Because they are less likely to include hospitals or post-acute care facilities, physician-led organizations may face greater challenges than other ACOs in managing transitions between settings of care and managing hospital-based care, if it is provided by hospitalists who do not have a formal relationship with the ACO.”