Two-thirds of physicians in ACOs say they've not benefited financially

A new survey suggests that what many doctors have feared all along about accountable care organizations may be true - that ACOs won't create any financial benefit for physicians.

More than two-thirds (67%) of physicians who participated in an ACO last year reported no personal financial benefit, such as a bonus or shared savings agreement, as a result of their participation, according to a survey of about 3,500 physicians from staffing firm Jackson Healthcare.

That compares with 19% of ACO participants who weren't sure if they'd benefitted financially, and 14% who said they had.

"I am not paid well enough for all the work I do and responsibility I carry as a primary care physician," said one survey respondent who wasn't identified. "Too much of the work is paperwork, which does not enhance the quality of patient care. I feel pressured to increase the number of patients I see, but this makes me feel like I would be practicing assembly-line medicine, which is not why I chose a medical career."

Of course, it's important to acknowledge the limitations of the survey. The roughly 3,500 respondents were self-selected from a group of about 225,000 doctors who received the survey via email. Of those respondents, 25% said they were currently participating in an ACO.

Further, ACOs are a relatively new phenomenon, so it's possible that they could offer financial benefit to physicians in the future, and that it's simply too early to have expected that to happen yet.

While the lack of financial gain will likely make many physicians wary of joining ACOs, participating in a physician-led ACO may be a slightly more desirable alternative than one led by a hospital.

Physician-led ACOs are certainly growing in number. With the latest round of ACO approvals from the Centers for Medicare & Medicaid Services (CMS) earlier this year, physician-led organizations pulled ahead of hospitals 202 to 189.

In a contrast with hospital-owned ACOs, physician-led ACOs achieve savings differently, Neil Kirschner, PhD, senior associate of regulatory and insurer affairs for the American College of Physicians, told Medical Economics recently.

Physician groups work to save money by keeping patients out of the hospital by taking better care of them upfront. Hospital-led ACOs focus on better managing patients once they are admitted, he said.  "Physician groups may have more freedom to work out how to succeed in a shared savings plan than a hospital," Kirschner said.

Still, many physicians are likely to resist the call of ACOs in a desire to remain independent. Those doctors would probably agree with analysts like Clayton Christensen and Jeff Goldsmith, who predict ACOs are doomed to fail.

"The only way to reduce costs is to reward physicians and patients for making high-value choices," Goldsmith told Medical Economics last month. "ACOs are a fundamentally paternalistic model that marginalizes both of the key actors in medicine."

Subscribe to Medical Economics'weekly newsletter. It's free!