Healthcare Practice Strategies – Fall 2012 - Working in an ACO: Questions to Ask

Healthcare reform’s focus on quality, efficiency and accountability make alignment with Accountable Care Organizations (ACO) an appealing prospect for many physicians.

Details on how ACOs will be organized and governed are still sketchy. In the end, ACOs may vary widely in their governance, quality improvement strategies and how any shared savings will be distributed.

Physicians seeking employment in an organization that will be structured as an ACO should seriously consider a number of different issues affecting their employment, including these:

  • Compensation – How will salary and bonuses be tied to the ACO’s ability to achieve cost savings (i.e., how will any savings be distributed)? Obviously, you’ll want as much information as possible about the other participants in the ACO.
  • Peer review – How will peer or professional review affect physician employment status? For example, what are the repercussions of failing to meet quality measures? Likewise, will peer review information from one organization be shared with other organizations within the ACO or any payors who contract with the ACO?
  • Quality standards – How will quality standards and protocols for integrated treatment be developed? And how will they affect physicians’ medical decisions?
  • Liability – Traditionally, physicians have been able to accept or refuse to treat a patient or a group of patients, as well as choose which physicians or other healthcare professionals to collaborate with. Is there any additional risk of physician liability that will be encountered by joint participation with other organizations or physicians? Will the physician be protected by the employer’s insurance policy?
  • Personal expenses – If participation in the ACO requires providers to travel to other participating organizations, will automobile and other personal and travel expenses be reimbursed?
  • Termination – Does the ACO have the right to expel a physician? How will this impact the employment relationship with the participating employer?

Healthcare Practice Strategies – Fall 2012 Issue

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