The ACO Rule: Small Physician Practices Can Benefit, Too

Just days after HHS released its mammoth-size ACO proposal, practices and medical associations weighed in on what parts of the rule are important to focus on, comment on, and get excited over. That said, nearly everyone Physicians Practice spoke to said the proposal raises many questions for physician practices and their potential healthcare partners. 

One immediate positive that stood out to Roland Goertz, president of the American Academy of Family Physicians, is that the rule addresses how providers in small or solo practices, especially in rural parts of the country, might enjoy the benefits of an ACO program.

“Number one, we’re pleased there is an interest to make sure all practice sizes can play a part in an ACO model,” said Goertz. “We were really concerned: Would a small practice in a rural area be allowed in an ACO model? [Officials] have covered that in the proposal.”
 

The 429-page document, entitled “Medicare Program; Medicare Shared Savings Program: Accountable Care Organization,” outlines how teams of physicians, hospitals, and other healthcare providers might work together to coordinate and improve care for Medicare patients - and save money in the process. To share in savings, ACOs are expected to meet quality standards in five key areas: patient/caregiver care, care coordination, patient safety, preventative health, and at-risk population/frail elderly health.

The proposed program is scheduled to begin on Jan. 1, 2012; public comments on the proposal are due by early June (60 days after publication).
 

Though he admits he hasn’t had a lot of time to digest all 429 pages of the proposal, Goertz echoed the sentiments of many stakeholders on antitrust concerns. He also said his organization will provide more direction to family physicians on how and whether to join an ACO model in coming months.

Late last week, the American Medical Association also praised the ACO proposal, but cautioned that any significant barriers to physician participation must be addressed, “including the large capital requirements to fund an ACO and to make required changes to an individual physician's practice, existing antitrust rules and conflicting federal policies,” said Jeremy A. Lazarus, a physician and speaker for the American Medical Association House of Delegates.

Lucien Roberts, associate administrator of business development at MCV Physicians, the medical practice of the Virginia Commonwealth University Health System, also noted some benefits of the proposal, which he plans to study in greater detail.
 

“ACOs are just one of several initiatives that HHS is putting forward,” said Roberts. “It’s getting most of the press right now, but there’s more going on with bundled payments, medical homes, and value-based purchasing. The most effective ACOs would be ones run by a very tight primary care practice. But I think most of the ACO initiatives will be system driven at this point. One of the things that I like about the proposed regulations is they’re very patient centric.”

Laurie Morgan, healthcare consultant with Thousand Oaks, Calif.-based Capko & Company, said the ACO proposal raises a lot of questions - not only on the role of small practices, but also how hospitals will target small practices, and how shared savings will be distributed.

“One thing we noticed is there’s a fairly high hurdle of scale for groups to qualify for this, with the 5,000 Medicare/Medicaid patient minimum,” said Morgan, noting that many small practices today do not meet those patient minimums.

Healthcare consultant Bruce Kleaveland said that while some questions are unanswered, ACOs could benefit tech-savvy providers.

“The good news is that a lot of work ACOs are going to require [is already] required by the meaningful use [goals],” he said. “For practices that haven’t made a transition to EHRs yet, it will be challenging for them to participate in any ACO.”