Physicians Remain Skeptical Despite Reported ACO Benefits

Early returns indicate that Accountable Care Organizations (ACOs) improve clinical quality as well as patient safety and satisfaction, and help to contain health care costs. However, the results of a recent survey by The Physicians Foundation reveal that few physicians are buying into the ACO concept.

According to the 13,500 physicians nationwide who responded to the survey, only 9% believe that ACOs will enhance quality and reduce health care costs. In addition, only one in five (21.9%) say their practice or employer is actively seeking designation as an ACO.

Travis Singleton, senior vice president at Merritt Hawkins, which conducted the survey on behalf of The Physicians Foundation, isn’t surprised by the results.

“People are a little shocked that we’re not surprised by the data,” Singleton explains. “But when you look at how providers truly feel about ACOs and their formation or overall effectiveness, this has been the climate for some time.”

Successful, yet skeptical

Less than two years ago, Health Care Service Corporation, through its Blue Cross and Blue Shield plan in Illinois, and Advocate Health Care teamed to launch an ACO partnership — BCBSIL/Advocate ACO. During the first year (2011) of operation, the ACO experienced a 4.6% cost improvement in the market, with improved clinical outcomes like lower readmission rates, which translated into $45 million in total projected savings.

Despite the early success, Bill Patten, divisional vice president of network management for HCSC, understands physician reluctance to openly embrace the ACO concept. Physicians are used to the fee-for-service model and a system that provides incentives for volume. The ACO model represents a change, which people in general are resistant to.

“Physicians have a foot in the fee-for-service boat, and they know they should have a foot in this accountable care boat, and they don’t know which boat to jump into, and when,” Patten says. “So, it doesn’t surprise me one bit that they’re reluctant, because none of the incentives have been lined up right for them to be doing anything differently than they’ve been doing.”

Losing control

Singleton says that when it comes to the formation of ACOs, there are two significantly different viewpoints. One is the theoretical viewpoint of what an ACO should do, which is often highly politicized, and then there’s the provider viewpoint.

“The provider standpoint is that there is always a fear that someone is trying to control their practice,” Singleton says. “That someone is going to try to better manage, or add different barriers or layers to how [physicians] control care.”

And then there are the demographics. Singleton says that, according to survey results, the younger female physician tends to be more optimistic than even the younger male physicians. On the other end of the spectrum, those who tend to be more pessimistic tend to be older male physicians, many of whom are still independent practice owners.

“When you look at the physician workforce today, by and large the new physicians entering the workforce for the last three to four years, and who will continue to enter the workforce for the next five or six, are predominately young female physicians,” Singleton says. “So you have a shift in population. Then you have this crop of employed physicians, and oh by the way, they’re likely to be younger, who have grown up in this system; who have grown up with electronic medical records; who have grown up with some form of population management; who have grown up with at least some of the analytics of health care reform. So they’re much more apt to that world.”

Cost and confusion

Another component to the ACO conundrum, Singleton says, is “the ticket to play, the barrier to entry.” He says that even if physicians believed that physician-led ACOs would work, just to gain entrance to the event means investing in information technology; investing or partnering with a health plan or hospital on population management analytics; and hiring consultants to help the physician identify where there are gaps in care.

“When you get into ACOs, forget the fact that we still don’t know what one is, right?” Singleton asks, rhetorically. “Forget the fact that we finally just decided — if you want to call it decided — on regulations and metrics for quality, which not everyone agrees with. And our survey clearly shows that almost 30% of the providers out there don’t even understand it, which is another problem.

“But then you get into the whole debate of, let’s say this works,” Singleton continues. “Who’s going to be the person or entity that is going to distribute those payments equally and equitably among those entities that were involved in the care? And more importantly, who’s going to decide, ultimately, if care is needed at all for that patient? And that’s where you start to get into what makes providers uncomfortable.”

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