ACOs are here: Cardiology practices must act, not react

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Cardiologists may have to quickly assess whether to align themselves with accountable care organizations (ACOs), an author of the emerging ACO concept for healthcare said. In a speech to cardiologists and practice leaders from around the U.S., Steven Lieberman cautioned that cardiology practices must think through both clinical and business issues before pulling the trigger.

Lieberman, formerly an assistant director of the White House Office of Management and Budget and executive associate director of the Congressional Budget Office, who is currently a visiting scholar at the Brookings Institution, told attendees at MedAxiom's Fall Conference in Scottsdale, Ariz., Oct. 6 that while ACOs are a broad concept applicable to a wide array of settings, they will rapidly gain in importance under the healthcare reform legislation pushed by President Barack Obama and passed by Congress earlier this year.

In remarks at the conference, Lieberman said that cardiologists may soon be faced with the choice of joining one or more ACOs, with potential varying outcomes. While ACOs are designed to associate pools of patients with healthcare providers, allowing those providers to share in any cost savings, ACOs also make those providers accountable to simultaneously provide better care at less cost.

In assessing whether to participate in or form ACOs, he said, "Given the technical requirements of how ACOs work, there are a number of variables to be considered."

Examples of such considerations include "the stability of the patient pool, changes in the disease status of assigned beneficiaries, opportunities for lowering cost while improving quality, and whether cardiologists are acting more as primary care physicians coordinating overall care or are seeing their patients on a more transactional basis as specialists."

Lieberman also said that in many cases, cardiologists who have integrated their practices and are employed by larger healthcare organizations may have the ACO decision made for them by the larger group.

Integration is a key issue facing many practices today. A MedAxiom survey earlier this year revealed that more than half of all cardiology practices across the U.S. have already integrated with larger healthcare groups or are seriously considering doing so.

Lieberman has previously noted that ACOs require a minimum of 5,000 Medicare enrollees, but the recommended minimum number is 15,000 commercial patients. ACOs have gained greater prominence at a time when the federal government and many private health insurers are actively considering sharply lower reimbursement rates for services provided by cardiologists and other medical specialists.

"Issues such as the growth of ACOs must be at the top of virtually every practice's agenda," said Patrick White, president of MedAxiom, a cardiology practice service provider based Neptune Beach, Fla. "Those that don't have it there face the prospect of having the market decide for them, which nobody wants or can afford in today's rapidly changing healthcare environment."