Becker's Hospital Review

Clinical Integration & ACOs 21 Survey: Number of Hospital-Employed Physicians Up 6% By Anuja Vaidya M ore physicians were employed by hospitals in 2013 than in 2012, according to a survey conducted by Jackson Healthcare, a healthcare staffing company. For the survey, 3,456 physicians were polled between March 7 and April 1, 2013. When asked which form of employment they chose, respondents reported the following, according to the survey:  • Employed by a hospital — 26 percent reported this in 2013, up by 6 percent from 2012. • Have ownership stake in a practice — 22 per cent reported this in 2013, down by 1 percent from 2012 • Have a solo practice — 15 percent reported this in 2013, down by 6 percent from 2013. • ork for physician-owned practice/has no W ownership stake in a practice — 15 percent reported this in 2013, up by 3 percent from 2012. • mployed by practice that is owned by a hospiE tal or health system — 14 percent reported this in 2013, down by 1 percent from 2012. • s an independent contractor — 8 percent reI ported this in 2013, down by 1 percent from 2012. n ACOs and Shared Savings Agreements: 16 Statistics By Molly Gamble  O ut of 85 payer arrangements, more than one-third were for upsideonly shared savings, but the upside option was noticeably lacking in commercial markets, according to an analysis by Premier. • ommercial payers: ACO arrangements with commercial insurers C typically result in the provider receiving 50 percent to 80 percent of any achieved savings. Shared savings agreements typically come in two forms. An upside-only agreement involves no downside risk for failing to achieve cost targets. An agreement with downside risk involves providers agreeing to "pay back" any spending over the cost benchmarks. • mployer payers: Employers offer some of the broadest arrangeE ments, with anywhere from 100 percent of savings with downside risk, to 50-50 shared savings arrangements in upside-only arrangements. n Fifty-seven percent of upside arrangements fell within the Medicare Shared Savings Program or Medicare Advantage, while 7 percent of upside arrangements were reported within Medicaid, 7 percent with provider-owned health plans and 7 percent with self-insured employers. Among the accountable care organizations analyzed in the whitepaper, only 21 percent of commercial arrangements offered upside shared savings. Those contracts were clustered in just four markets and they also tended to be smaller in scope, usually for 5,000 covered lives or less. Premier also reported that nearly 70 percent of commercial payment arrangements to date have been limited to either care management fees or downside shared savings models. Here are some other major findings from the whitepaper, which details various ACO and payer arrangements among 22 health systems that are part of Premier's Partnership for Care Transformation Population Health Initiative. Percent of lives covered by model • Shared savings agreement with upside risk: 41 percent • Shared savings agreement with downside risk: 26 percent • Care management fees: 21 percent • Bundled payment: 9 percent • Capitation: 3 percent Range of savings provided to ACOs • ublic payers: The range of savings provided to the ACOs by public P payers, such as Medicare and Medicaid, runs between 25 percent and 60 percent. Report: 36% of Physicians Plan to Leave Medicine Within 10 Years By Anuja Vaidya   T hirty-six percent of physicians plan to retire or stop practicing medicine in the next 10 years, according to a survey conducted by Jackson Healthcare, a healthcare staffing company. For the survey, 3,456 physicians were polled between March 7 and April 1, 2013. The reasons cited for wanting to leave or retire, according to the survey, were: • eeling burned out — 60 percent cited this as one of the reasons. F • ot wanting to practice in an era of healthcare reform — 58 perN cent cited this as one of the reasons. • conomic factors such as malpractice insurance, overhead, using E EMRs, etc. — 50 percent cited this as one of the reasons. n

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