No Effect on Day to Day, for Now
"But we're not there yet," Dr Flansbaum says. "The ACO represents a mindset that the healthcare system is embracing. But we still live in the fee-for-service world. Depending on the local market's evolution and models of ACOs, they are still far removed from the mainstream of hospitalist practice."
For individual hospitalists, their parent health system's participation in ACO contracts has not yet percolated down to their daily work life, he says. The hospitalist might not even know whether a given patient is part of an ACO at the time of admission.
But there will be increasing expectations for quality and value. This will include, for example, effective patient transfers, prevention of readmissions, communication with primary and post-acute care providers, patient satisfaction scores, and other quality metrics. The percentage of beneficiaries who are in Medicare Advantage plans is growing, and more than 30% of Medicare payments are now made to health systems that reward quality and cost-effectiveness over volume of services provided.
"In 10 years, we'll all be in the population health business," says Ron Greeno, MD, MHM, senior advisor for medical affairs at Team Health, North Hollywood, California, and SHM's president-elect. "Hospitalists today are most involved with bundled payment models. But in all models, they'll see higher percentages of their revenue tied to performance metrics. Every healthcare organization in America is getting ready for this change," says Dr Greeno, who in October gave a keynote address, "Hospitalists in the World of Population Health," at the 14th Annual Rocky Mountain Hospital Medicine Symposium in Denver.
The good news for hospitalists, Dr Greeno says, is that they are an absolute necessity for success under the new payment schemes.
"I can't think of a single health organization in the country with managed care and population health experience that is successful without having a strong hospitalist program. From the start, we were not paid for billing productivity alone, but for what we contribute to our hospital or health system," he says.
Dr Greeno says hospitalists will need to do what they always do, but better.
"We'll need to be more efficient, with more focus on financial risk, and we'll be more heavily scrutinized by our health systems. As your hospital gets knee-deep into ACOs, you'll need to make good decisions about individual patients—providing the right care right now," Dr Greeno says.
There are still misaligned incentives in the system, but if a patient is in an ACO, that patient should come into the hospital only if they absolutely need to, he says.
"Eventually, it will be all about the lowest per capita cost for delivering high-quality care, and the hospitalist will be asked to support that goal," Dr Greeno says. "If you undertreat or discharge the patient too soon, it will come back to haunt you. If you get a call from the emergency department for an ACO patient, you'll want to hot-foot it down to that department and make sure the patient really needs to be admitted."
Medscape Internal Medicine © 2016 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: What Hospitalists Need to Know About Accountable Care Organizations - Medscape - Oct 25, 2016.