DALLAS—The accountable care organization (ACO) is an unknown for most physicians and administrators, partially because the government has not yet defined final ACO rules. However, radiology practices can and should begin to prepare for the transition to the ACO model. In fact, the push to ACOs provides an opportunity for radiology practices to re-imagine their businesses, said Jef Williams and Shawn McKenzie, both of Ascendian Healthcare Consulting, during a presentation Aug. 16 at the annual meeting of AHRA.
Williams and McKenzie offered a few facts behind the ACO phenomenon:
- More than half of Medicare beneficiaries have five or more chronic conditions.
- One in five Medicare beneficiaries discharged from the hospital is readmitted within 30 days.
- The U.S. spends 51 percent higher per capita on healthcare than the next highest nation.
The basics of an ACO are simple at first glance and eerily familiar to those who versed in earlier related efforts, such as capitation and health maintenance organizations (HMOs).
Key elements and goals of ACOs include coordinated care within and across enterprises; seamless, high quality care for Medicare beneficiaries and ongoing measurement of costs as well as outcomes. ACOs, said Williams and McKenzie, will reimburse organizations based on multiple factors, including patient experience and outcomes.
The model requires a shift away from siloed healthcare and practice-centered medicine to patient-centered care, Williams and McKenzie said.
Another major change on the ACO horizon, they added, is that the governing body of the ACO will include providers, payors and patients. Furthermore, the model does not have to be hospital-centric. Indeed, nearly 40 percent of organizations that plan to form ACOs in the next 12 months are physician practices.
With final rules slated for release later this year and pioneer ACO applications due in August, the ACO model is here, said Williams and McKenzie.
Impact on radiology
“Participating in an ACO means getting rid of the re’s—re-ordering, re-scheduling, re-imaging and re-reading. The old days of re-imaging the patient will cost the organization,” Williams and McKenzie said. That’s because payments are episodic, rather than fee-for-service.
The model requires providing information across the organization and to referring physicians and reporting data for quality measures. Radiologists and radiology resources can play a critical role in meeting both objectives.
At the organizational level, decision-makers need to understand the role of radiology, which requires radiologists leave the dark room and grasp a role in shaping the ACO. Williams and McKenzie predicted a return to a pre-PACS model, with successful radiologists acting as consultants—not commodities. Key consulting opportunities are:
- Clinical decision support;
- Radiation dose management strategies; and
- Data mining and business analytics for ACO reporting requirements.
On the IT side, an ACO requires standardized workflows, systems optimization and integrated IT because a lack of integration will cost money. Radiologists and administrators need to understand the relevance of technology that supports the model: vendor neutral archives, information lifecycle management and archive intelligence.
The starting line
It’s true that final ACO rules remain undefined. Yet radiology providers can prepare. “The imaging strategy has to get beyond buying the next CT scanner and incorporate becoming part of the ACO model.” The department should determine the current state of the business from the organizational, technical and clinical perspectives.
In addition to conducting an internal assessment, Williams and McKenzie encouraged radiology stakeholders to focus externally and build relationships with hospital administration, IT, radiologists and affiliated and non-affiliated physicians.
At the technology level, radiology practices should assess infrastructure with an eye on interoperability, systems consolidation, simplified systems and elimination of duplicate systems. As practices invest in new informatics systems, ACO considerations should play a role in the decision-making process. That is, new systems should utilize standardized exam codes, capture relevant data and enable reporting.
The changes required by the ACO model mirror a call voiced by radiology leaders for years. That is, for radiology to survive, the profession needs to get beyond PACS and efficiency and re-join the clinical world. It’s a challenging, but necessary, transition.