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Implementation Of Accountable Care Organizations

From the Disputing Blog of Karl Bayer, Victoria VanBuren, and Holly Hayes.

In his book, Beyond Neutrality, Bernard Mayer says, “Conflict resolution professionals are not significantly involved in the major conflicts of our times. Many conflict resolution practitioners play useful but essentially marginal roles in large-scale public conflicts… we are not involved at the center of the conflict or decision-making processes.”

This week, we posted about “clinical integration” or the creation of Accountable Care Organizations (ACOs). Is this an area where conflict resolution practitioners can play a “useful and essential role at the center of the decision-making process”? American Medical News has this to say about the development of ACOs:

The accountable care organization hit the mainstream when, in its June 2009 report, the Medicare Payment Advisory Commission discussed the concept as a way to reduce costs and improve care for Medicare beneficiaries, going so far as to discuss whether physician membership in ACOs should be mandatory. (The AMA countered that such projects be voluntary for physicians.)

The health system reform law passed on March 23 directed CMS to begin demonstration projects to test ACO projects nationwide, the most prominent being the Medicare Shared Savings Program, scheduled to begin by Jan. 1, 2012. That allows physicians to sign up, voluntarily, for ACOs, which must consist of at least 5,000 Medicare patients, and must run for at least three years.

…analysts say a sure thing is that the fee-for-service system, as constructed, is under attack, and that allying with fellow physicians and others in ACO might be a practical strategy to preserve, or even increase, income. And that’s why there is so much scrambling right now among doctors, and hospitals, to get involved with ACOs.

Much of the nitty-gritty has yet to be worked out, but experts say physicians should start thinking about how their practices may need to change if they want to be ready for the final rules, and be able to take advantage of possible bonuses.

“This doesn’t necessarily mean that physicians have to be employed, but they are going to have to work together,” Harold D. Miller, executive director of the Center for Healthcare Quality and Payment Reform in Pittsburgh, said July 12 at an American Medical Association seminar in Chicago. “We should not think that the only solution is large, integrated delivery systems. … You want to have multiple models and have some degree of competition.”

Those who work in this area say the first step is for physicians to think about the kinds of issues in their practice that incur the most significant health care costs and the connections that have the most potential to reduce them.

“We don’t really know how it’s going to work,” said AAFP President Lori Heim, MD. “Right now, it’s a theory.”

The words: change, competition, attack, allying, scrambling, work together, multiple models and theory, suggest there may be a role at the table for conflict resolution practitioners as the government, hospitals, health systems, physician practices and health care associations seek to implement the Accountable Care Organization model which, at its core, holds care providers “accountable” for utilizing resources to decrease costs and increase quality.

We welcome your thoughts on this topic.

                        author

Holly Hayes

Holly Hayes Bovio received a Masters in Health Administration (MHA) from Duke University and her undergraduate degree from Southern Methodist University. She holds a certificate in mediation from Texas State.  Holly brings a strong hospital operations background to healthcare mediations including a focus on clinical quality.  Holly managed her own consulting… MORE >

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