Otolaryngologists Missing from Leadership Ranks of Accountable Care Organizations

In addition, although ACOs focus on primary care, they are accountable for covering the entire cost of their patients’ healthcare, which includes surgery (but not drug costs). The study cites other research that shows that the average American has nine surgeries throughout his or her lifetime (J Am Coll Surg. 2008;207[3 Supp]:S75). Nationally, surgery represents approximately 50% of hospital expenditures and accounts for an estimated 30% of total healthcare costs (Ann Surg. 2010;251:195-200). “Even if ACOs are able to achieve their goals in chronic disease management, overlooking the role and cost of surgical care may negate those savings,” the study authors stated.

Benefits Seem Small

Surgeons can voluntarily join ACOs, and how it’s done varies by the market. “They may sign a formal participation agreement, or it could be an informal agreement where the ACO agrees to include them in their referral network in exchange for their commitments to following the ACO’s objectives,” Dr. Weissman said.

But by not joining ACOs, otolaryngologists don’t seem to be missing out on too much—at least not at the moment. “ACOs are very much primary care focused; the present quality measures are all in this realm and have little to do with otolaryngology practice,” said Lee D. Eisenberg, MD, MPH, partner at ENT and Allergy Associates, LLP, in Englewood, N.J. “Until we are more integrated into ACOs and the measures are more relevant to our practice, we have little to gain as most of the shared savings are likely to be given to primary care physicians.” He added that this standard is appropriate at present because these physicians carry most of the risk for reducing expenses.

Dr. Eisenberg continued, saying, “I am not sure that we will ever benefit from cost savings, because our component of cost is minimal compared with other surgical specialties with a much higher Medicare population as part of their practice, such as urology and ophthalmology, or those with high-cost surgical procedures in the Medicare population, such as orthopedics.”

Dr. Weissman agreed. “I think the shared savings incentive will not be enough, because by doing just one extra procedure, surgeons can probably earn more money than the shared savings they may be eligible for,” he said.

On the positive side, Dr. Eisenberg believes that otolaryngologists might be able to benefit from increased referrals, their main means of garnering patients.

As far as patients are concerned, Dr. Eisenberg doubts that otolaryngologists’ nonparticipation in ACOs will significantly affect patients’ ability to obtain otolaryngology-head and neck services. “A patient may be assigned to an ACO, but that does not limit his or her choice of otolaryngologist and the present referral patterns will persist,” he said, adding that not participating in an ACO has had little effect on his practice thus far.