60% Of Doctors Won't Join ACOs

By Christine Kern, contributing writer

Study finds that more than half of physicians have not joined ACOs

A recent study published on Wiley Online Library, Physician Practice Participation in Accountable Care Organizations: The Emergence of the Unicorn, has found that approximately six of 10 physician groups have avoided joining an ACO to date, and don’t have plans to join in the near future.

According to Modern Healthcare, the results suggest these reluctant medical groups lack the resources to effectively manage the costs and care for chronically ill patients, including electronic health records, care coordinators, and formal quality improvement initiatives. Study author Stephen Shortell, a University of California, Berkeley professor of health policy and management, said that success stories from early ACO adopters could provide an incentive for other groups to invest in the necessary resources to implement the ACO healthcare model.

When measured against an index of 25 measures of care management, patient engagement, and quality, not surprisingly, medical groups that already belonged to ACOs ranked highest, while those physician practices with no plans to join an ACO scored lowest, the study said.

Twenty-five percent of respondents from 1,180 medical groups surveyed were in ACOs. An additional 15 percent said they had plans to join an ACO soon. The groups were adjusted by researchers to reflect a nationally representative sample. “Early formative evaluations of pilot sites highlight the challenges of building capabilities in EHR functionality, predictive analytics, data-collection reporting and analysis, care management, physician and patient engagement, and the key roles played by culture and leadership,” the authors wrote.

Besides the uncertainty over the financial burdens of ACOs, many of these healthcare institutions are also concerned about how it may affect their hospital admissions and general practices. But the gap in readiness and resources between those that eschew and those that embrace accountable care suggest that widespread and rapid adoption of the payment model is unlikely, Shortell said. “We’re not on the scale ... where that’s going to occur,” he said. Too many medical groups lack the necessary capacity to manage the financial risk of accountable care.

That lack of capacity among such a large segment of physician groups is discouraging if accountable care succeeds at slowing health spending while improving quality, Shortell said.

It’s too soon to tell if that’s the case. Medicare ACOs met rudimentary quality goals for the first year, but were not required to show progress. Meanwhile, ACOs achieved mixed results on efforts to control health spending.

Medical groups already in accountable care were more likely to have 100 or more doctors and were less likely to be owned by a hospital. That may be because of financial incentives under accountable care to reduce, when possible, costly hospital admissions, the study said. “Our findings also suggest that those practices owned by hospital and health systems may be reluctant participants given that the new value-based payment models are likely to adversely affect hospital admissions and financial viability.”