Importantly, both ACOs solicited input from specialists in developing disease management programs for the entire organization. For an initiative on reducing unnecessary imaging for back pain, one ACO set up joint meetings with orthopedists, physical medicine and rehabilitation providers and primary care physicians, and then paid them all for their time in developing best practices. “Here’s the punch line: There could be pay-for-performance and upside potential in that situation that says, ‘If we reach certain metrics, both in quality and efficiency, then a bonus will be shared with the specialty group that participated in that area,’” Dr. Coppola said.
Explore This IssueApril 2013
Although otolaryngologists may still be paid to perform procedures on a fee-for-service basis, Dr. Coppola sees them taking on more responsibility in helping ACOs decide how to allocate limited resources across an entire population. In other words, more upfront collaboration might contain costs and prevent unnecessary care. “So there’s a great opportunity for a group of otolaryngologists to come together and work with an ACO and develop these medical management plans,” Dr. Coppola said.
In negotiations with any provider group, however, he cautioned that otolaryngologists should push for an emphasis on quality. “I would be very wary of anybody who came and said, ‘Look, we want you to provide care for 90 cents on the dollar,’ and then they walk away and there’s no discussion about quality,” he said.
Making a smooth entry into an ACO may require both time and energy. But, as otolaryngologists find their place in the new era of accountable care, Dr. Coppola said, the new opportunities will be well worth the effort. “I think the message to the otolaryngologist is that you want to be involved,” he said.