In an ACO, Who's Accountable?
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Ah, but that’s what managed care has done and has continued to do, much to the chagrin of many, if not most, patients and physicians. For example, over the past four years or so, managed care organizations have required preauthorization of imaging, although they have backed off of preauthorization in many other areas.
“The cost is really not in seeing the doc,” he says. “You can’t get the imaging anymore unless it’s preauthorized, so that’s how you manage utilization.”
The Access to Medical Imaging Coalition says in a report that imaging utilization has decreased since the Deficit Reduction Act of 2005, which included the provisions to do so. For instance, the use of CT, MRI, PET, and nuclear services grew by only 1.1%, much slower than before. Meanwhile, screening mammography and the use of dual energy x-ray absorptiometry to detect osteoporosis continue to decline in volume.
Much of the discussion about ACOs has hovered over what entity will have control. Will it be a business entity? Will it be a bunch of joint ventures? Those issues will be worked out, say those who have already embarked on accountable care. The main issue that needs to be solved is clinical integration among a wide variety of players in patients’ healthcare.
“Why does it have to be a hospital-based initiative?” asks Simon Prince, MD, president and CEO of Beacon IPA in Manhasset, NY. Prince and his colleagues believe an independent practice association can do the trick. He’s already got 200 physicians in his IPA, and he believes they are nearly ready for ACO-style healthcare.
“There are still a bunch of us private practitioners, but there’s also a lot of consolidation in our marketplace. Docs are running to the hospital for safety and security in fear of healthcare reform. Staying put in a private practice silo and not doing something may not be the right solution,” he says. “But it seemed there are other alternatives.”
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