10 Things You Need to Know to Succeed and Be Happy in an ACO

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July 28, 2015

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7. You Have Some Leeway in Applying Guidelines

CMS regulations governing ACOs require the use of evidence-based medicine (EBM), which involves basing clinical decisions on research results. A CMS summary[6] of the final rules for ACOs states that they should "have in place procedures and processes to promote evidence-based medicine, beneficiary engagement, and coordination of care."

But Dr Dera says no one is expecting ACO doctors to constantly adhere to EBM. "For the majority of patients, EBM protocols are best," he says, "but there's a reason why they're called 'guidelines.' Physicians should deviate from a guideline when it's best for patient care."

In fact, some authorities have attacked overuse of EBM. A 2014 article[7] in the British Medical Journal stated that it should be taken with a grain of salt because it's based on studies of a wide group of patients and may not apply to the specific conditions of a particular patient. Comorbidities, for instance, often require a different approach, and sometimes standards have to be modified to deal with patients' preferences.

Dr Habis says doctors at Meritage are also given a wide berth to deviate from guidelines. "Generally, physicians are allowed to use the guidelines as they see fit," he says. "They're allowed to differ in terms of style of practice. There isn't one way of doing things." For example, Meritage doctors can decide how often they see the patient and under what circumstances.

However, Dr Jacob at Northwest Ohio says physicians still need to take guidelines more seriously than they do now. "We can no longer say, 'But this is how I do it' or 'This is how I was trained,'" he says. "We have to start applying EBM more widely."

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