Weighing the pros and cons of joining an ACO

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To many health care professionals, Accountable Care Organizations (ACOs) represent an evolving model for medicine in the United States. The idea seems simple enough. First, develop a network connecting family physicians or general practitioners with specialists. Then, provide incentives for that network to achieve demonstrable improvements in patient health. However, the Academy's "2012 Dermatology Practice Profile Survey" suggests that dermatologists have been reluctant to join ACOs. To help understand that reluctance, Member to Member spoke with Maryland skin cancer specialist Ali Hendi, MD, who recently weighed the pros and cons before deciding to accept the challenge of ACO membership.

AAD: The Academy's "2012 Dermatology Practice Profile Survey" revealed that only 4 percent of dermatologists belong to or participate in an ACO. Why do you think dermatologists are hesitant to join ACOs?

Dr. Hendi: The ACO concept is still evolving, and dermatologists are not really sure exactly what the benefits and drawbacks of membership will be. As with any new concept, there is a great potential for fear and anxiety. Dermatologists may expect to be penalized for any number of reasons.

AAD: What are some of the specific concerns?

Dr. Hendi: Perhaps the most immediate concern is a lack of a direct incentive for some specialists. Under current ACO models, the financial incentives for improving patient health mostly go to general practitioners or family physicians. There are, however, some ACOs set up by specialists to treat patients with chronic diseases such as congestive heart failure, diabetes, or cancer. Some specialists are included in incentives/shared savings.

Treatment of specialists, however, is not uniform within ACOs and can be determined by the particular specialty, the local market, and the ability of the specialist to bargain or negotiate. Also, a dermatologist’s experience within one ACO may not be reflective of his or her experience in another.

AAD: Are there indirect benefits to ACO membership for dermatologists?

Dr. Hendi: One obvious, indirect benefit is providing a source of new patients. And, of course, the most important benefit is improved patient care.

AAD: Do you feel that ACOs will improve the health care experience for patients?

Dr. Hendi: It is certainly possible, particularly by enhancing coordination among general practitioners and various specialists. A major issue in health care right now is patient care coordination. Take for example a patient who is diagnosed with diabetes by a family physician. The patient may need to see an endocrinologist, a podiatrist, and various other specialists. 

There was once a sense that the family physician would coordinate this type of care. But in reality, family physicians and general practitioners are busy, making it difficult to follow up with every single patient and specialist. In an ACO, much of this work is handled by dedicated patient care coordinators.

AAD: What are some other concerns regarding ACO membership?

Dr. Hendi: Many dermatologists, I think, fear that ACO membership will increase the burden of administrative work. Dermatologists are busy professionals, and their office staffs already handle plenty of paperwork. There is a concern that membership in an ACO will add an additional level of complexity.

AAD: Has this proven true in your case?

Dr. Hendi: I have only been in an ACO for six months, so it may be a bit early to tell. So far, the additional burden has not been great. Membership required our office manager to do some set-up work. But we have not noticed a deluge of additional paperwork.

AAD: Given the uncertainties, what made you decide to join an ACO?

Dr. Hendi: The information I received from the Montgomery County Medical Society laid many of my fears to rest. In the end, most of the factors seemed to equal out; there was no direct incentive, but also no investment or risk. Given that, it seemed worth accepting the challenge of something new.

AAD: What advice would you give to colleagues who are considering ACO membership?

Dr. Hendi: I would say to go for it. You do not have to put up any money or resources, and you maintain control over your own practice. More importantly, you have a chance to take part in what may very well be the future of medicine.

Ali Hendi, MD, is board-certified in dermatology and operates a surgical facility dedicated to the treatment of skin cancers in Chevy Chase, Md. He serves as a clinical assistant professor of medicine (dermatology) at the Georgetown University Medical Center. Dr. Hendi has published 20 peer-reviewed articles and book chapters. His most recent book, the Atlas of Skin Cancers, was published in 2011.

Email the Member to Member editor at members@aad.org.

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