Accountable care: Don't wait until the learning curve is too steep

As FierceHealthcare reported last week, the Center for Medicare & Medicaid Services (CMS) final rule for accountable care organizations (ACO) made participation in its Shared Savings Program a more attractive, feasible goal for more physician practices.

This Monday at the Medical Group Management Association's Annual Conference in Las Vegas, healthcare attorney Bruce Johnson, partner with Polsinelli Shughart in Denver, concurred that the relaxed rules will encourage more groups to participate in this particular demonstration project.

However, Johnson told the audience, "I will wager that the majority of your communities will not participate in one of those formal structures. Does that mean you can continue on with business as usual? In my view, the answer is no; you're still going to have to change by creating new relationships and doing things differently to participate in a new payment system."

Indeed, copresenter, Deborah Walker Keegan, president of Medical Practice Dimensions in Arden, N.C., said that when it comes to accountable care, the train has left the station. "The states aren't waiting, and the payers aren't waiting. The integrated delivery systems aren't waiting for any type of demonstration to occur," she said. "They are aligning now for clinical integration, for collaboration, and to position themselves to really be competitive in value-based purchasing."

For practices that aren't yet in some way laying the groundwork to participate in providing accountable care, Johnson and Walker Keegan urged that the time is now to begin planning incremental steps to develop relationships and infrastructures that will help move them forward toward the accountable care continuum.

During this period of transition from fee for service to what Johnson and Walker Keegan predicted will be a fundamentally changed way of paying for and delivering care, physician groups can look to existing models of accountable care to help plan their futures.

For example, although Medicare's Shared Savings Program might not be the right fit today for all practices, groups can look at it as a roadmap for how to create a clinically integrated network, Johnson said.

Johnson also predicted that a form of CMS' Hospital Value-Based Purchasing program will eventually be applied to physician practices. "You don't know what that's going to look like for you, but you can look at the Hospital Value-Based Purchasing rule, look at the basic mechanism of what that rule uses, and that ought to provide you a preview of what the future is likely to look like for physician value-based purchasing," he said.

For practices, there are a number of legal, financial, and structural considerations related to the numerous existing models of accountable care. For instance, although physicians' ability to form a large group practice under a single tax ID is easier and has a successful track record, groups still face the challenge of getting their doctors on board, Johnson said.

Alternatively, a professional services agreement between a physician group and a hospital, which Johnson referred to as "employment light," might offer some of the benefits of alignment without surrendering independence completely.

The bottom line, according to Walker Keegan, is that accountable care is not going away. "The problem is if you wait until the experiments are done and you decide too late to get on board, the learning curve is so steep to learn how to collaborate, to do clinical integration, to manage transitions of care, to reduce the cost of care, and to really implement some of the processes, either internally for a medical group or externally with aligned partners ... ," she said, "if you wait too long, then the real concern is you're going to be left off by yourself."

For more information:
- check out the CMS Value-Based Purchasing Program website
- see the MGMA conference website

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