Two recent studies of accountable care organizations show that the biggest obstacle to their implementation is buy-in from the physician community, and survey data support that claim. But are physician attitudes divided by age and if so, can ACOs be seen as generational issue?

 

At this point, physician pushback is being closely documented. A survey of 882 administrators and physicians by San Diego-based staffing company AMN Healthcare recently found that 42 percent of respondents engaged in ACO formation see physician alignment as the most serious obstacle to their efforts, ahead of lack of capital, lack of integrated IT systems and lack of evidence-based treatment protocol data.

 

Similarly, a recent joint poll from KPMG, EpsteinBeckerGreen and JHD Group revealed that physician participation in ACOs is seen by 36 percent of respondents as “the greatest challenge” to implementation, ahead of cost, staff skill sets and management buy-in.

 

The AMN Healthcare survey “underscores the central issue regarding both ACO formation and the industry-wide effort to enhance quality of care and reduce costs,” said president and CEO Susan Salka. In order for the ACO model to work she said, “health facility leaders and physicians must align their interests, communicate and cooperate.”

 

Brad Benton, KPMG Healthcare’s national account leader, agrees that “clinical leadership and integration will be a key ACO operational consideration.” Because of the change management issues involved with ACOs, the initiative represents “a complex transformation challenge of the highest order,” he said.

Brave new world

 

Interestingly, physician support for ACOs can be gauged along generational lines, observes George Whetsell, managing director for Chicago-based Huron Consulting.

 

“Buy-in depends on which physician you talk to – the younger ones have been educated with prevention and wellness and health promotion, so it not a foreign concept to them,” he said. “More and more young doctors are choosing to be employed rather than form a private practice. The older doctors who’ve been in an entrepreneurial style model will be less inclined to participate.”

 

Yet because the rule is only proposed and not final, physician input to CMS may result in some changes they find more favorable, said Scott Weingarten, CEO of Los Angeles-based Zynx Healthcare.

“It is hard to buy into the program when you don’t have all the details and know that the rule is subject to change,” he said. “If CMS addresses the concerns that many physicians have, there might be greater acceptance.”