5. You'll Need to Be a Team Player
Team care, which involves divvying up responsibilities according to each member's training, is an important concept in an ACO, explains Dr Dera.
"We follow the concept 'tasks for staff, decisions for physicians,'" he says. "The higher-level decision-maker is not good at routine tasks. As a clinician, there's no reason that I should be giving flu shots or ordering routine lab tests. That can be done by others."
However, at Northwest Ohio ACO in Toledo, a joint venture between the Toledo Clinic and University of Toledo Physicians, some doctors initially fought being part of a team, according to Moshir Jacob, MD, one of the ACO's four medical directors.
Dr Jacob says the ACO has dramatically lowered such indices as emergency department (ED) visits, hospital admissions, and cost per beneficiary, and is well on its way to earning a bonus. Whereas 20% of the bonus would go to the ACO, the rest would go directly to each provider, on the basis of the number of beneficiaries seen.
Despite this incentive, he says, some doctors didn't give the ACO's new care managers, who were supposed to work closely with each doctor, their full cooperation. "They refused to take their calls," Dr Jacob says. "I had to speak to them about it. They don't do that anymore, because they realize the care managers help them improve their patients' outcomes."
Research[4] has shown that when responsibilities are divided, a practice can save a significant amount of money. In one study,[5] having one assistant gather data during the patient visit allowed the practice to increase visits by 30% or more.
Nevertheless, Dr Jacob says working in teams is a difficult transition for many physicians. "We were taught to work individually," he says. "We're used to making our own decisions, taking our own approaches."
In some practices, physicians do a variety of jobs themselves—even filling out forms or measuring blood pressure. But in an ACO, they're expected to hand over these responsibilities to others, so they can concentrate on the work that only they can do.
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Cite this: Leigh Page. 10 Things You Need to Know to Succeed and Be Happy in an ACO - Medscape - Jul 28, 2015.
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