What Hospitalists Need to Know About Accountable Care Organizations

Larry Beresford


October 25, 2016

In This Article

Being Part of the Conversation

Hospitalist Ami Parekh, MD, JD, acknowledged a widely used metaphor for healthcare today: "Yes, we are in two payment systems right now. But we've got to put them together and make a catamaran. If we don't, we could fall in the water," she says.

Dr Parekh is executive director of population health and accountable care for the University of California, San Francisco (UCSF) health system, although she still sees patients in the hospital and outpatient clinic. UCSF Health participates in five commercial ACOs, she explains. Her biggest challenge, she says, is to educate staff about healthcare reform.

She explains it this way: "Someone from the health system is going to come up to you in the not-too-distant future and say something like this: There's this subset of ACO patients for whom I would like you to check in 3 days after discharge. You need to do a clear, doctor-to-doctor handoff and, if they get readmitted to the hospital, we want the same doctor to see them. And we want you to communicate more with other doctors in our system, and with post-acute care providers. We will also be looking at patient-reported outcomes for your patients at 90 days."

John Nelson, MD, MHM, a hospitalist at Overlake Hospital Medical Center in Bellevue, Washington, as well as a consultant and SHM cofounder, says that he too is trying to stay abreast of these new payment models.

"Recently, I've been thinking a lot about how much full-time clinicians should be expected to know this stuff. They can focus on the broad outlines, but leave it to others to keep up with the details," he says.

Perhaps someone in the hospitalist group can volunteer to be the expert on accountable care, just as many groups have a designated leader in health information technology.

"I can't think that frontline doctors should feel obligated. It's just too much to keep up with all the details," Dr Nelson says. "Eventually, a health system administrator will come to your group with new performance metrics. But I'm sure there will be room for give and take. They can't just start measuring you without your participation in that conversation."


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