First survey of ACOs reveals surprising level of physician leadership

In spite of early concerns that hospitals' economic strengths would lead them to dominate the formation of Accountable Care Organizations (ACOs), a new study published in the June issue of Health Affairs reveals the central role of physician leadership in the first wave of ACOs.

"The broad reach of leadership in ACOs has important implications for the future of reform", said Carrie Colla, PhD, lead investigator of the study. "A central role for physicians in the leadership of ACOs is likely to have a powerful influence on how both physicians and patients view the ACO model."

ACOs are groups of providers that are held responsible for the care of defined populations of patients. The key notion is that the providers within the ACO receive financial rewards for both improving the quality of care and reducing the growth of costs. The Affordable Care Act established this new, voluntary federal program for Medicare, and many private insurers are adopting the model. Over 600 Accountable Care Organizations (ACOs) are now operating in the U.S.

In the first analysis of the National Survey of ACOs, the research team from the Dartmouth Institute for Health Policy & Clinical Practice found that the majority of ACOs identified as physician led, with another third jointly led by physicians and hospitals.

The study compared physician-led ACOs to other types of ACOs and found that physician-led ACOs were more likely to have comprehensive care management programs in place and advanced IT capabilities. They are also more likely to measure and report financial and quality performance at the clinician level and to provide meaningful and timely feedback to clinicians.

"These findings suggest that physician leadership will be an important factor in initiatives to improve the quality and cost of care," said Mark McClellan, MD, former Administrator of the Centers for Medicare and Medicaid Services (CMS), now at the Brookings Institution. "Physician-leaders may have a leg up when it comes to working with their colleagues to identify opportunities to improve care and to measure impact."

The study also documented the diversity of organizations participating in accountable care programs. Some ACOs are made up of only primary care physician practices, some are multispecialty physician practices, while others are integrated delivery systems and include providers across the continuum, such as hospitals and post-acute care providers.

"Physicians' buy-in to payment reform is likely to be critical to the success of the ," said Elliott Fisher, MD, MPH, Director of the Dartmouth Institute and a co-author on the paper. "The findings suggest that physicians are taking seriously their responsibility to lead change in the health care system on behalf of their patients." Previous research has shown that involving physicians in the governance of provider organizations improves communication and builds trust by assuring practicing physicians and clinical staff that their professional values are represented. Physician governance also assures patients that their needs will be considered along with those of the organization, the researchers said.

More information: content.healthaffairs.org/cont… nt/33/6/964.abstract

add to favorites email to friend print save as pdf

Related Stories

Will minorities be left out of health care law provision?

Apr 26, 2011

Hospitals and physician practices that form care-coordinating networks called "Accountable Care Organizations (ACOs)," under provisions of the new health-care law could reap cost-savings and other benefits. However, experts ...

Recommended for you

New toilets for India's poor, crime-hit village

21 hours ago

More than 100 new toilets were unveiled Sunday in a poverty-stricken and scandal-hit village in northern India, where fearful and vulnerable women have long been forced to defecate in the open.

Can YouTube save your life?

Aug 29, 2014

Only a handful of CPR and basic life support (BLS) videos available on YouTube provide instructions which are consistent with recent health guidelines, according to a new study published in Emergency Medicine Australasia, the jo ...

Doctors frequently experience ethical dilemmas

Aug 29, 2014

(HealthDay)—For physicians trying to balance various financial and time pressures, ethical dilemmas are common, according to an article published Aug. 7 in Medical Economics.

AMGA: Physician turnover still high in 2013

Aug 29, 2014

(HealthDay)—For the second year running, physician turnover remains at the highest rate since 2005, according to a report published by the American Medical Group Association (AMGA).

Obese or overweight teens more likely to become smokers

Aug 29, 2014

A study examining whether overweight or obese teens are at higher risk for substance abuse finds both good and bad news: weight status has no correlation with alcohol or marijuana use but is linked to regular ...

User comments