While Primary Care Physicians are integral to the proliferation of a successful ACO, its unrealistic to think that beneficiaries will not need specialty treatment at some (or many) points in their episodes of care. ACOs need specialists, too! So… I’m a specialist, should I join an ACO?
The short answer:
Are you willing and able to lose referrals?
If you’re a specialist that has chosen not to join an ACO, are you willing to risk losing referral sources? Your primary care friends that have joined an accountable care organization are no longer going to refer to a specialist that isn’t a part of their “team”; they are going to refer within the ACO network, where they can keep tabs on their patients and better serve the mission of accountable care. The PCP will give their patients their recommended specialist to follow up with. Patients are more likely to choose a provider recommended to them by their PCP.
The Greater Good
Health care spending in the United States is up to nearly 20% of GDP.
According to the Centers for Medicare and Medicaid Services, “national health care spending is projected to grow at an average rate of 5.5 percent per year for the next 8 years.”
The US spent nearly $1.1 trillion on healthcare in 2018. By these projections, this spending will reach over $6 trillion by 2027.
Medicare spending accounts for over 20 percent of the Untied State’s healthcare spending. With the growing population of baby boomers, this number will only rise. The good news is that you can help change this. Fee-for-service payment structures only incentivize providers to increase the volume of patients. Your participation in an accountable care organization can reverse the volume-based care trend and the growing burden on our economic system.
You could bring a lot to the table – financially.
Specialty care costs more – period. Care provided by primary care physicians accounts for about 50 percent of all physician office visits per year. However, only about 30 percent of the costs are associated with primary care. This means that specialists are accounting for most of the healthcare expenditures in the office visit environment. Thus, specialists have the most opportunity to bring in Medicare savings.
More in medicare savings means…
more in shared ACO savings…
…which means more money for you.
If there is an established ACO in your region or your main referral sources join an ACO, you should seriously consider joining. The final decision should come only after weighing the costs versus the benefits of joining an Accountable Care Organizations.
What’s the bottom line?
While CMS continues to shape the rules surrounding accountable care organizations, they are here to stay. CMS will continue to push for value-based care models as the baby boomer population continues to burgeon Medicare spending. Joining the game early on in its evolution may just benefit you in the future when you can declare yourself an established leader in specialty ACO care.
Be sure to keep up with this 5-part series as we explore other FAQs about Accountable Care Organizations such as What is an ACO? and Primary Care Physicians and ACOs – Should You Join? Up Next: Financial Results for ACOs