Wednesday, December 21, 2011

The ACO Divide: "Pioneers" Vs Private Practitioners

The independent, private practice model will be largely, though not uniformly, replaced. Most physicians will be compelled to consolidate with other practitioners, become hospital employees, or align with large hospitals and health systems for capital, administrative and technical resources.

The Physicians Foundation, “Health Reform and the Decline of Physician Private Practice, “ A White Paper Examining the Effects of the Patient Protection and Affordable Care Act on Private Practices in the United States, October 2110

December 21, 2011- This week Health and Human Services announced with considerable fanfare 32 "Pioneer" Physician Organizations that qualified after competition to become “Pioneer” Accountable Care Organizations (ACOs). These ACOs will begin their work on January 1, 2012 and are designed to save Medicare $1 billion over the next 5 years by boosting quality while improving outcomes and reducing costs.

These 32 organizations, selected from among 80 applicants, hail from 18 states. They now care for 880,000 Medicare beneficiaries. Six of the fledgling ACOs are from California, 5 from greater Boston, 4 from Minnesota, and 3 from Michigan.

The 32 "Pioneers"

The “winning” organizations, if you want to call them that, include:

Allina Hospitals and Clinics (Minneapolis), Atrius Health (Massachusetts), Banner Health (Phoenix), Bronx Accountable Care (New York City), Brown and Toland Physicians (San Francisco), Darrtmouth Hitchcock ACO (New Hampshire and Vermont), Eastern Maine Health Care System(Maine), Fairview Health System (Minneapolis), Franciscan Alliance (Indianapolis), Genesys PHO (Michigan), Healthcare Partners and Medical Group (Los Angeles and Orange County), Healthcare Parnters of Nevada), Heritage California ACO (California), ISA Medical Group (Orlando-Tampa), Michigan Pioneer (Michigan), Monarch Healthcare (California, Orange County), Mount Auburn Cambridge IPA (Massachusetts), North Texas ACO (North Texas), OSF Healthcare System (Illinois), Park Nicollet Health System (Minneapolis), Partners Health (Massachusetts), Physicians Healthcare (Denver), Presbyterian Health System(New Mexico), Premier Medical Network (Southern California), Renassiance Medical Management Company(SE Pennsylvania), Seton Health Alliance (Central Texas), Sharp Healthcare System (San Diego), Steward Healthcare System (Massachusets), TriHealth System (Iowa), University of Michigan (SE Michigan).

These organizations hardly represent U.S. physicians as a whole. Many are in the most progressive cities in the more liberal states of the U.S. – in California, Massachusetts, Minnesota, Michigan, and New England.

Great swaths of the U.S., 32 states in all, have no ACO representatives.

These states include those in the far West (Hawaii, Alaska, Oregon, Washington State, Idaho, Montana, Utah, Wyoming), the Midwest and Southwest (North and South Dakota, Nebraska, Oklahoma, Missouri, Ohio, Kansas), the entire South (North and South Carolina, Georgia, Alabama, Mississippi, Tennessee, Kentucky, Arkansas Louisiana, Virginia, West Virginia), parts of the East (Connecticut , Delaware, Maryland, New Jersey).

These organizations do not include physicians and health systems that care for 47 million other Medicare recipients. Moreover, many of the “pioneers” are hardly that. They are well-established groups with salaried physicians and the infrastructure, finances, and administrative teams to handle the bureaucratic demands of ACOs.

It may be, of course, that 88% to 90% of physicians who practice outside of these “pioneer” ACOs, will see the light and invest money, time, and energy and will take the risk of creating these new organizations. It may also be that prestigious organizations like Mayo, the Cleveland Clinic, the Marshfield Clinic, Geisinger, academic medical centers, like Duke, Johns Hopkins, and prestigious New York and Pennsylvania centers, and other intergrated medical school-centered systems, will join the reformation and climb upon the ACO bandwagon.

It will be a waiting game to see if the 32 “pioneers” can produce results envisaged by Washington CMS and HHS planners and founders of these early ACOs.

Maybe, just maybe, other physician organizations will cross the Great Divide between private practice in fragmented solo or small groups to an organizational Nirvana. It will take more time, more experiments, more results, and more federal incentives.

When one uses the term “Accountable Care Organization,” a fundamental question arises. ”Accountable to whom?” To the federal government? To the experts and managers who designed these organizations? To the organizations who implement them? To the defined populations of the elderly they serve?

Health and Human Services has announced 32 “pioneer “ medical organizations have agreed to become experimental ACOs, starting in January 2012.


Anonymous said...

Good morning, Interesting post. I saw a post on Sermo (physician community board describing one practitioner's experiences with being enrolled in an ACO without his permission...

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