Monday, March 25, 2013

Physician Survey Shows Docs Prefer ACOs for Their Market Clout, Not Quality

Physicians climb aboard the ACOs
Talk about spin.

Deloitte has released its 2013 Survey of U.S. Physicians that examines attitudes about health reform and the current practice environment. A random sample of 20,472 physicians from the AMA's master file of physicians were invited to participate.  While only 613 (a 3% response rate) surveys were returned, the DMCB thinks the results are intuitively credible. 

What was interesting was how the Deloitte writers chose to report the data.

Most interesting was the description of physician attitudes about accountable care organizations (ACOs).

Here's Deloitte's word-for-word reporting:

"Physicians report that accountable care organizations (ACOs) will be successful to some extent in achieving improved quality (introduction of performance reporting and benchmarking, 37% better identification and closer management of high-risk patients, 28% and improved population health, 21%) and reduced costs (use of lower-cost treatment settings and providers, 21%)."

Exsqueeze me, but this makes the DMCB believe that a majority of respondent physicians do not believe ACOs will be successful in performance reporting and benchmarking (63%), better high risk patient identification and management (72%) or population health (79%). A similar large majority (79%) do not believe cost savings will be be achieved.

So, asks the DMCB, if the numbers are so dreary, why are physicians apparently flocking to work in ACO settings?

Says Deloitte:

"However, physicians currently working in ACOs diverge from those not in ACOs in their views on capitation bundled payments and Medicaid reimbursements. Three in 10 physicians currently working in ACOs chose to work in an ACO environment with high-quality, evidence based care standards."

So only a minority (30%) of physicians are attracted to ACOs' claims that they offer high quality and evidence-based care settings?

That's right.  Read on.....

"Physicians identify the trade-offs between larger (e.g., large medical groups, health systems, hospitals, and health insurance plans) versus solo practices. Larger practices are perceived to be better placed to secure superior third-party payer contracts and offer the greatest financial success potential, whereas solo practices are perceived to offer greater clinical autonomy. Larger work settings offer better conditions for contracting with third-party payers (89 percent of all physicians feel this way) whereas clinical autonomy was a valued feature of and more likely to be a feature of solo practices (81 percent of all physicians)."

In other words, when it comes to the grand convergence of physicians and ACOs, it's not about quality and efficiency.  It's all about giving up clinical autonomy in exchange for income preservation and the market dominance that leads to local negotiating clout.  

The finding - albeit in an imperfect survey - that few docs who work in these settings have faith in the promise of increased quality or efficiency does not bode well for ACOs.

Stay tuned! 

1 comment:

Vince Kuraitis said...

Jaan, My take here is that docs almost entirely will be working for the hospital (IDS) or medical group, NOT the ACO itself. In turn, the hospital or medical group will have a contract to provide services to the ACO.

Big difference between contracting with an ACO and working for an ACO.

There is probably perceived security in working for the old dog, but I doubt that security is real.