Physician alignment presents biggest obstacle to ACOs

A survey finds doctors and health facility administrators often on different sides when it comes to patient care, cost and reimbursement.

By — Posted July 25, 2011

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The biggest challenge to forming an accountable care organization is physician alignment, according to one survey. It's such a big challenge, 40% of organizations not forming ACOs point to that as a reason why.

A survey of 882 physicians and health facility administrators by AMN Healthcare asked respondents about their participation in ACOs, the perceived obstacles to their formation, and whether they believe ACOs would deliver cost and quality benefits.

Accountable care organizations are confederations of doctors, specialists and hospitals working to coordinate care, administer payments, determine quality and safety benchmarks, and measure performance. All parties would receive shared savings.

Physicians and health care facility leaders reported that physician alignment was the most serious obstacle to forming an ACO. The two sides often are conflicted about patient care, cost, reimbursement and governance issues, according to AMN Healthcare, a health care work-force staffing and management firm in San Diego.

Alignment is often defined as all parties agreeing to shared goals and the means to achieve them.

"While capital and data are essential to forming ACOs, the success of this emerging model turns on people," said Susan Salka, president and CEO of AMN Healthcare. "Health facility leaders and physicians must align their interests, communicate and cooperate for this model to work."

Fifty-eight percent of those surveyed indicated that their organizations were forming an ACO or were considering doing so. The other 42% said their organizations would not be forming an ACO in the foreseeable future.

Of those who are moving toward ACO formation, 42% said physician alignment is the most serious obstacle, followed by lack of capital (38%), lack of integrated IT systems (31%), and lack of evidence-based treatment protocol data (25%).

Forty percent of those not forming an ACO cited physician alignment as a reason.

The survey also found high hope that ACOs would deliver quality and cost benefits. Fifty-nine percent either strongly or somewhat agreed that ACOs would deliver benefits and that they are key to enhancing quality and reducing costs. Forty-one percent either strongly or somewhat agreed that ACOs would deliver benefits.

AMN Healthcare said physician alignment continues to be an issue, and that it remains unclear who will lead these organizations.

In April, the American Academy of Family Physicians and several other state societies published a blueprint for successful ACO formation. The report's authors said physicians favor autonomy over collaboration, but that doctors and hospitals will have to learn to work together.

"While strong hospital-physician alignment has always been a cornerstone of success, the necessary degree of future collaboration, partnership and risk-sharing will dwarf what has come before it," the authors of the AAFP report wrote. "Hospitals and physicians will have to recognize, embrace and leverage their growing interdependence to create organizational structures and incentive models that are strategically aligned and mutually rewarding."

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