If they prove viable, the exchanges also may help accelerate the trend toward more consolidation of physician practices or growing pressure to align with larger entities. Despite concerns over skinnier networks, for example, the more tightly controlled access to providers under certain plans dovetails with the ACA’s heightened emphasis on more integrated accountable care organizations (ACOs).
Explore This IssueJanuary 2014
In fact, ACOs and other lower-profile provisions that enjoy more bipartisan support could ultimately play key roles in reshaping how healthcare is delivered in the U.S. Many of these reform efforts have been launched as pilots or demonstration projects. Salt Lake City-based healthcare consulting firm Leavitt Partners tallied nearly 500 ACOs through the end of July 2013, more than double the total in June 2012.
Other ACA provisions are levying fines based on excessive hospital-acquired conditions or readmissions and adjusting reimbursements based on e-prescribing, the Physician Quality Reporting System (PQRS), meaningful use of electronic health records, and other mandates. “The overall theme is that the ACA is speeding up the move away from fee-for-service payment toward new payment methodologies that are going to be increasingly based on quality measures,” said Dr. O’Malley.
“All of these are basically efforts to shift incentives away from rewarding volume of services toward value and quality of care for patients,” she said. “And the crux of all of them is to try to get physicians to work together, not only with other specialists and their primary care colleagues, but also with other inter-professional members of their team.” That means nurses, medical assistants, social workers, mental health providers—anyone who can have a big impact on patient outcomes across the spectrum.
The need to share resources, Dr. O’Malley said, may be yet another factor in the accelerated rate of practice consolidation. “There’s pressure among docs not just to function as teams but to consolidate among themselves either through physicians’ organizations like IPAs [independent practice associations] or becoming employees of hospitals,” she said. “That’s where you get economies of scale and shared infrastructure to do a lot of the things that the ACA is requiring of them.”
Consolidation or not, she sees plenty of potential for increased efficiency. Some medical groups may need to hire more support staff, she said, whereas others may simply require more coordination among existing staff to lighten the load. “I think increased emphasis on teamwork and delegation of tasks that don’t require a physician’s level of training is something that’s going to get a lot more attention moving forward,” she said.