Choosing a Business Model: Accountable Care Organizations

Ryan Syrek, MA; Robert L. Wergin, MD


June 23, 2016

Editor's Note:
From young physicians considering their first practice model to experienced doctors contemplating a change, the advantages and disadvantages of a new situation can be overwhelming. For this fifth and final installment in a series examining various business models for physicians, we asked Robert L. Wergin, MD, to give us his perspective on the ins and outs of an accountable care organization (ACO) model. Dr Wergin is medical director of Crestview Care Center in Milford, Nebraska.

Medscape: Could you describe the basics of the ACO model?

Dr Wergin: The Medscape Family Physician Compensation Report from 2016 found that family physicians earn, on average, $207,000 annually. The American Academy of Family Physicians (AAFP) does not have any salary information specific to physicians who practice in ACOs. There is no standardization of physicians' salaries in an ACO. It all depends on the payers and contracts.

ACOs provide higher payment for quality with a similar mix of compensation based on productivity and salary. As a companion to the Medicare Shared Savings Program, various risk-sharing, cost-reducing models have emerged within the private sector. Commercial ACOs, like their Medicare counterparts, are networks of healthcare providers that may receive payments based on shared savings for defined populations over a period of time. To achieve shared savings, certain quality and performance metrics must be met. Specific contract lengths and risks vary from payer to payer.

According to the AAFP 2015 Practice Profile Survey, respondents said they worked an average of 47.3 hours per week. That breaks out to 34 hours in direct, face-to-face patient care; 1.8 hours doing preauthorizations; 7.7 hours for other patient care tasks (non‒face-to-face); and 3.8 hours on other nonclinical duties. The AAFP has no ACO-specific data regarding hours worked. Additional resources may be available in an ACO practice to allow for more efficiency. This varies by ACO and practice.

Medscape: What are the advantages of practicing in this setting?

Dr Wergin: Joining an ACO can help improve practice efficiency, quality of care, and patient satisfaction. As we move toward a payment system that rewards value and efficiency, being part of an ACO may give some physicians a leg up. In addition, successful ACOs have a strong primary care base and leadership.

An important part of ACO care delivery is team-based care that allows all providers to practice at the top of their licensure. Tasks are delegated appropriately so that physicians focus on work that is required to be done by physicians, whereas nurses, physician assistants, and other staff take on additional patient care responsibilities that may challenge and reward them with a sense of greater professional satisfaction.