By Daniel M. Siegel, MD, December 03, 2012
A move toward more integrated care delivery has been on the mind of payers and the government for years. You can see it in the incentives Medicare has offered for adoption of electronic health records. At first all you had to do to earn bonus payments was have a functioning EHR. But new criteria require more data sharing, both between providers and with patients, and the intended path forward is clear: Interoperability between all providers, and seamless sharing of patient information between primary care doctors and specialists. It may take some time, but that’s where things are headed in the long term. Dermatologists who have many years of practice left who have thus far avoided EHR adoption are faced with the question of when, not if, they will go electronic — the incentives are rigged in that direction.
In the immediate future, though, dermatologists are faced with another pressing decision: Should they join an ACO?
Accountable care organizations, or ACOs (some pundits think it stands for Amazing Consulting Opportunities as the legal rules are very unclear!), are a new twist on an old idea — make a group of doctors responsible for the overall health of a population of patients and pay them, at least in part, according to the results. ACOs create strong incentives for care coordination on the assumption that such coordination will lower overall system costs.
In August, the Academy’s Board of Directors held an in-depth strategic discussion of ACOs and their impact on dermatology. Were dermatologists already participating? Our most recent survey indicated only 4 percent were. Should more of them be? And what would members who wanted to be part of an ACO need to know, and do, to make that possible? [pagebreak]
As a result of that strategic discussion, the Academy developed an online ACO Resource Center. You can visit it at www.aad.org/ACO. From this one page of our website, you can access all of the tools you need to make an informed decision about whether joining an ACO is for you. It includes links to a variety of information about where the idea of ACOs came from, how the Academy has advocated regarding them, and a summary of the rules related to ACOs that have been published by the Centers for Medicare and Medicaid Services. It brings together all of the ACO-related content that Dermatology World has published over the last two years, including advice from the magazine’s legal columnists, in-depth articles unpacking the most important considerations for dermatologists and the best ways to make themselves attractive to ACOs, and descriptions of the ACO experience of members who are already in one. And it includes the nuts-and-bolts information you can use to make your decision — whether you need to know what to do if an ACO approaches you or you’re wondering how to approach an ACO. The resource center can help you determine if you should accept an ACO’s terms. It can also help you make your case if you want to join an ACO, with a series of documents you can use to help demonstrate to your ACO of choice the value that dermatologists can bring.
Of course, dermatology’s participation in ACOs will evolve over time, and so will the Academy’s resources. Next month’s issue of Dermatology World, for instance, will include articles about legal considerations related to joining an ACO and negotiating with an ACO. These will be added to the resource center as soon as they are published. We’ll also add testimonials from dermatologists who are successfully participating in ACOs — if you’d like to offer yours, or have questions about ACOs, please contact ACO@aad.org.
The advent of ACOs may represent a turning point for health care, or it may be, like capitation and HMOs and so many other models, another stop on a long and winding road. Either way, your Academy is committed to making sure you have the information you need to make the right ACO decision for yourself and your practice.