Defining the Typical ACO-participating Practice

Physicians Practice has written extensively about what accountable care organizations (ACOs) look like (groups of healthcare providers partnering up to improve care quality while reducing care costs). We’ve written about what ACO reimbursement looks like (participants share in the cost savings with payers if they improve care quality while reducing care costs). We’ve even written about what the technology needs within an ACO look like (EHRs, patient registries, and clinical decision support tools are critical).

But we haven’t written about what the typical ACO-participating practice looks like.

To help shed some light, we analyzed the nearly 1,200 responses we received to Physicians Practice’s 2013 Staff Salary Survey. Here are some of the most noteworthy ACO-related findings:   

A higher percentage of larger practices participate in ACOs:
Overall, about 16 percent of our survey respondents said they participate in an ACO. When we broke down our survey findings by practice size, however, it became clear that a higher percentage of survey participants from larger practices were participating in ACOs than the percentage of respondents from smaller practices who were doing so.  

In fact, 41 percent of respondents who said they were in 20-plus physician practices said they were ACO participants, while only 12 percent of physicians who said they were in solo practices said they were. In two- to five-physician practices, 13 percent of respondents said they were ACO participants; in practices of six to ten physicians, 17 percent said they were participants; and in practices of 11 to 20 physicians, 23 percent said they were participants.

ACO participants are hiring differently:
When we compared staffing trends among ACO participants to staffing trends among non-ACO participants, we noticed that ACO participants more commonly employed care coordinators (an individual whose sole job is to coordinate patient care and/or offer referrals to other healthcare providers). More specifically, 33 percent of ACO participants said they employed a care coordinator, while only 18 percent of non-ACO participants said they did. In addition, 26 percent of ACO participants said they have added a care coordinator to their staff in the past five years, while only 7 percent of non-ACO participants said they had.

ACO participants also more commonly reported adding a registered nurse to their staff in the past five years (38.7 percent said they had added one while only 17 percent of non-ACO participants said they had done so). ACO participants also more commonly reported adding a physician assistant (16 percent said they had added one while only 12 percent of non-ACO participants said they had added one). They also more commonly reported adding a nurse practitioner (26 percent said they had added one while only 22 percent of non-ACO participants said they had added one).

While the difference in hiring trends could be explained by the fact that larger practices are participating in ACOs more often than smaller practices, it could also have to do with the fact that ACOs focus on team-based coordinated care. Individual like care coordinators, physician assistants, and nurse practitioners, all help supplement a team-based care approach.

ACO participants are more commonly located in certain regions:
Of survey respondents who said they were part of an ACO, the highest percentage (26 percent) were located in the Plains and Rockies/North Central Region, which we characterized as Colorado, Iowa, Idaho, Illinois, Indiana, Kansas, Michigan, Minnesota, Montana, Nevada, North Dakota, Ohio, South Dakota, Utah, and Wyoming. In contrast, of all survey respondents (ACO participants and non-ACO participants), about 18 percent said they were located in this region.

Overall, about 15 percent of our survey respondents (ACO participants and non-ACO participants) said they were located in the Southeast, which we defined as Alabama, Florida, Georgia, Missouri, and South Carolina. When we considered ACO-participating practices only, however, only 9 percent said they were located in this region.  

The full results of our 2013 Staff Salary Survey are available here.