Otolaryngologists Prepare for the Era of Accountable Care Organizations (ACOs)

Charles F. Koopmann, MD, associate chair and professor of otolaryngology at the University of Michigan in Ann Arbor, cites multiple areas of potential cost savings within otolaryngology. Improved efficiencies in the diagnosis and treatment of otitis media, otitis externa, sinusitis and vertigo, as well as in the use of imaging technology, could all yield considerable savings. Similarly, Dr. Coppola sees a high potential for improved care and efficiency in sleep medicine. Because the specialty is weighted heavily toward in-facility testing, in sleep labs, he said, doctors aren’t reaching enough patients, the per-patient cost is too high and too few resources have gone into nonsurgical treatments.

The cost consequences of an untreated condition like sleep apnea (the medical focus of NovaSom, Inc.) can be enormous given the increased risk for diabetes, heart disease and stroke, Dr. Coppola said. Unlike a medical insurance company, he said, an ACO acting as regional care provider might be able to adopt a longer-term solution that includes more preventive medicine. “I think there’s a huge opportunity for people who are proactive, who are forward-thinking, to develop new ways of approaching things, and take the system that we have and make it a higher-quality, more efficient system,” he said.

Figuring out exactly how to involve otolaryngologists, however, is still very much a work in progress. Dr. Koopmann, for example, wondered how easy it would be for specialists to join an ACO and whether a leading otolaryngologist in a smaller market could join more than one. If so, how would that specialist’s performance metrics be scored? And if an otolaryngologist sits down with a pediatrician to develop criteria for the proper diagnosis of otitis media but isn’t the first provider to see such patients, how should an ACO view that specialist’s contributions? “Even though I’ve helped them set up the standards, how do I get rewarded—or potentially not rewarded—if there’s improvement in whatever metrics have been put forth?” Dr. Koopmann asked.

A few potential templates for how to proceed are beginning to emerge. Dr. Coppola, unlike most other otolaryngologists, has had experience as both a provider and board member in two ACOs—one that contracted with large commercial payers and a second that functioned as a managed Medicare plan. As a group, he said, the physicians were better able to solve population health problems. The ACOs also yielded enhanced revenue for the doctors and led to higher professional satisfaction for both the providers and office staff due to a perception that they were working as a team to create solutions.