Study Finds ACOs Overlook Surgeons: 5 Key Findings

A new study has found Medicare's early ACOs have put little emphasis on surgical care, even though it accounts for roughly half of hospital expenditures.

Instead, the ACOs have focused on chronic conditions, readmissions and emergency department use.

For the study, published in Health Affairs, researchers examined how surgical care has been organized in the initial 59 Medicare ACOs and how surgeons are being engaged, if at all. The study used mixed methods, including case study interviews with four ACOs representative of the initial Medicare rollout in terms of ACO type (Pioneer or Shared Savings Program), organizational leadership (physician led or hospital led) and geographic diversity. It also used a survey, to which 30 of the 59 ACOs responded. Both surveys and case study interviews were administered between June and November 2012.

Here are five key findings from the study.

1. When asked to indicate the priority that they were placing on various objectives during their ACO's first performance year, only 10 percent ranked the goal of reducing unnecessary surgery as a high or very high priority. Eighty-six percent of respondents rated the goal of reducing unnecessary surgery as a medium, low or very low priority.

2. On the other hand, 97 percent of respondents considered reducing avoidable hospital readmissions as a high or very high priority. Reducing avoidable ED visits got the same rating from most (94 percent) survey respondents.

3. Seventeen of the ACOs that responded to the survey reported planning to distribute shared savings from the first year of operation, and all seventeen planned to distribute the savings to their primary care physicians. Eight of the seventeen ACOs, or 47 percent, planned to share savings with surgeons and other specialists, as well.

4. Not one case study interviewee could say — or would even estimate — how much of their ACO's total expenditures were attributable to surgery.

5. When asked, "How well integrated is the care between the surgeons and primary care physicians who serve patients in your ACO?" only 11 percent of the survey respondents thought that their ACO provided perfectly or very well integrated care. An additional 25 percent thought that their organization's care was well integrated, but needed improvement. Sixty-four percent thought that their ACO's care was not well integrated or needed lots of improvement, or said that they didn't know the answer to that question.

More Articles on ACOs:
CEOs: Population Health Experience is Hardest Skill Set to Find
Top 5 Strategies to Ensure Ongoing Success in the Medicare Shared Savings Program
6 Value-Based Payment Models Most Used by Healthcare Providers


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