ACOs: Stepping stone toward risk for independent physicians

A few years ago, independent physicians appeared headed for extinction. In 1983, more than three-fourths of physicians worked in private practice. Today, according to the American Medical Association, less than half of U.S. physicians—47 percent—are independent.

Happily, the outlook for private practice today has brightened. And one of the reasons is the growth of accountable care organizations (ACOs).

Providing improved care at a lower price

ACOs, part of the Medicare shared savings program, are all about coordinated care among a team of providers. Kaiser Health News describes an ACO’s key features:

ACOs make providers jointly accountable for the health of their patients, giving them financial incentives to cooperate and save money by avoiding unnecessary tests and procedures. …Those that save money while also meeting quality targets keep a portion of the savings. Providers can choose to be at risk of losing money if they want to aim for a bigger reward, or they can enter the program with no risk at all.

The latter is what’s appealing to many independent physicians. Most are perfectly happy to take on more risk. But doing so at the same time they’re paying for multiple new mandates—electronic health records systems and quality measure collection—can threaten the whole practice.

Medicare’s solution? A new “track” that takes on some risk, but less risk than previous ACOs. Thus, starting this year, providers can now choose from a wider variety of tracks—from no risk to greater risk—with escalating rewards.

Getting used to taking on risk

As it turns out, the new track is popular. The number of ACOs participating in a program with some level of risk doubled in 2018, from 9 percent last year to 18 percent in 2018. Prognosticators expect steady, but gradual, growth in ACOs, including the higher-risk tracks.

From an independent physician’s viewpoint, it’s another way to maintain autonomy during a period of major health care reform. In an ACO, they can benefit from assistance with technology, data and reporting requirements, while testing the risk waters gradually. That’s quite a bit better than extinction.

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