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Accounting for Independent Physicians

Philip Betbeze, for HealthLeaders Media, June 13, 2011
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Innovative and forward-thinking organizations haven’t been waiting around for the government to act before transforming the way they deliver care. Yet even with proposed regulations out for accountable care organizations, many organizations are still taking a wait-and-see approach. But Summa Health System’s top executives and a cadre of independent physicians don’t see the value in waiting, and have been working diligently to create the structures and systems required to deliver care that is better and cheaper—in short, an ACO.

In many ways, Summa possesses the ideal infrastructure for an ACO. It has a health plan with 155,000 lives, 25,000 of whom are enrolled in the Medicare Advantage plan. Although it has contracts with other insurers, ownership of the health plan allows for a true closed loop between the payer and the provider. Summa has most of the pieces of the continuum of care, from urgent care clinics to a Level I trauma unit in a full-service acute care hospital. It also has much of what’s in between, including long-term care. Finally, Summa has a CEO who sees ACO creation as a strategic imperative. But despite all those advantages, the health system still has a formidable challenge in integrating physicians in the community who are not employed. Its staff numbers more than 1,000 physicians, only 255 of whom are direct employees.

“Summa has the health system that fits this model,” says Tom Strauss, the president and CEO of the seven-hospital, Akron, OH-based system. “The health system physicians, both employed and affiliated, and SummaCare [health plan], allows us to move toward ACOs. It’s a sweet spot for us because not many in our state have this ability.”

More than 700 of Summa’s physician staff are independents, and their participation is essential to its ACO project. That’s where many hospitals and health systems see substantial hurdles to attaining the continuity of care and shared responsibility for patient outcomes that is central to the ACO concept.

Strauss sees significant hurdles there as well, but his leadership team is actively taking on the challenge.

“Creating this ACO is my No. 1 objective for this year and next,” he says. “We want as many physicians as possible to join our model. If you stay with the old system, your payment is just going to be ratcheted down.”

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