10 Potential Blunders by Providers in ACOs

Tags: accountable care organization | ACO | antikickbacks | antitrust | EHR | hospital management | Stark Law

The Journal of the American Medical Association has outlined 10 potential mistakes providers may experience when developing an accountable care organization, whether with CMS or with private payors.

1. Overestimating their ability to manage risk, particularly when potential rewards are at stake.
2. Overestimating their ability to use electronic health records, which can disrupt medical practices for six months or more.
3. Overestimating their ability to report performance measures — a task that is likely to evolve slowly over time.
4. Overestimating their ability to implement standardized care management protocols, largely due to the amount of time it takes for clinicians to develop, assess and implement them.
5. Failure to balance the interests of hospitals, primary care physicians and specialists when creating governance and management processes.
6. Failure to sufficiently engage patients in self-care management, since many ACOs will have little experience with this degree of patient engagement or self-determination.
7. Failure to make contractual relationships with cost-effective specialists, since specialists are not required to limit their activity to a single ACO under proposed rules. This will emphasize referral relationships, and entrenched relationships with high-cost specialists will be a setback for some ACOs.
8. Failure to navigate the new regulatory and legal environment. This includes understanding exemptions from Stark law along with antikickback and antitrust legislation.
9. Failure to integrate beyond the structural level because the ACO may lack change management or implementation skills required to improve care delivery.
10. Failure to recognize interdependence. This means the failure to see the above nine mistakes as a series of connected events, or a constellation, where each one will be exacerbated by the other.

Read the full-length story on ACO mistakes in The Journal of the American Medical Association.

Related Articles on ACOs:

Lawyers Have Problems with ACOs, Too
Blue Shield of California, St. Joseph Health System Form Accountable Care Initiatives
7 Reasons Hospitals Struggle to Align With Physicians

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