Physician Led ACOs- Opportunities and Challenges

Opportunities:

1. Create a more cost efficient healthcare system- Accountable Care Organizations (ACOs) have the opportunity to spend healthcare dollars more wisely by delivering high quality care and ultimately saving money. Turning away from the standard fee-for-service model and focusing on the value for the patient, has allowed ACOs to gain recognition in the healthcare industry.

2. Improving overall population health- The sharing of information between all members involved in an ACO allows for the right care at the right time in the right setting. The patient is the complete center focus in this interconnected system and the hopes are for ACOs to benefit the general health field using this mindset.

3. Taking advantage of IPAs– There is a big opportunity for ACOs to benefit by using IPAs as a basis and general set of guidelines. They already have existing infrastructure, management, IT, and organizational components, which have proven successful and can be utilized.

Challenges:

1. Adopting new technologies- As ACOs are beginning to grow, new technologies need to be implemented into the systems. According to Becker’s Hospital Review , “though installing an electronic medical record is a necessary step toward ACO formation, it needs to connect the hospital to its outpatient and physician office locations. Additionally, the organization needs to commit to monitoring clinical and claims data, as well as risk management.”

2. System of how physicians are getting paid- A study done of 632 physicians and published in Annals of Family Medicine proved that even though doctors are supposed to have their incomes tied to quality, it is only slightly the case. Their incomes were only two percentage points higher tied to quality than the incomes of doctors in traditional practices. This is too similar to the way doctors are already getting paid, and it is not providing an incentive enough for them to work in ACOs.

3. Legal issues- ACOs have to make sure they are in accordance with the Antitrust Law and the Stark Law in terms of safety zones, cost savings, and coordinating care for Medicare.

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