In an ACO, Who's Accountable?

For those physicians who still want to be small business owners, Beacon IPA offers one example of how to retain a measure of independence, says Prince, who wanted to avoid forming a large group multispecialty practice in favor of the IPA for a number of reasons.

“One of the disadvantages of the multispecialty model is that you come in under one tax ID and you lose your individuality in favor of corporate activities—a lot of the things that make your practice your practice,” he says.

Further, he says it’s easier to attract physicians if the organization is easier to get into and out of.

“If you’re unhappy, you can leave fairly easily, but when you dissolve a corporation, it’s a much bigger hassle.”

It’s also easy to get rid of physicians who aren’t meeting the mandates of the IPA, which include some of the goals in ACOs, such as clinical integration and other infrastructure, such as a common electronic medical record system. That said, Prince is not yet completely committed to forming an ACO with Beacon, which is only a few months old. Much of that depends on the cooperation with private payers and CMS, after all.

But early signs are encouraging, he says. He’s courting third parties to help with billing software, determine what corporate functions of the IPA they can farm out. Also, he wanted to use an EMR that wasn’t necessarily linked to any one hospital or health system, so that the IPA can have a dialogue with payers allowing the IPA to remain free agents.

In general, as he’s spoken with all the commercial payers in his region, they are more supportive of his group than he anticipated, he says. 

“There’s an appetite for this type of physician-led initiative. Competition is probably one reason because having a competitive playing field is important to the payers and our patients. If every practitioner runs en masse to a hospital or health system, it doesn’t help with that competitive balance.”

Payers, he says, want quality, value, and the understanding that the physicians in the IPA will police themselves. “They want assurances that we will work with them on cost savings,” he says.

One of the main initiatives of the IPA is to set up evidence-based guidelines for physician behavior to help limit overutilization.

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