Becker's Hospital Review

Sign up for the COMPLIMENTARY Becker's Hospital Review CEO Report & CFO Report E-Weeklies at www.BeckersHospitalReview.com or call (800) 417-2035 Similarly, Jeff Goldsmith, who is the president of Health Futures, warned in the same article that: Source: Wilde Mathews, Anna. "Can Accountable-Care Organizations Improve Health Care While Reducing Costs?" Wall Street Journal, January 23, 2012. Large physician groups can also be well-positioned to develop ACOs. ACOs, however, are very expensive to develop, with estimates of the real cost to develop them tending to be very high. Further, ACOs largely favor a tightly knit system where one can ensure that patients are seen by physicians and providers at in-network rates, rather than out-of-panel and out-of-network rates. Thus, the development of shared savings agreements and ACOs is another institutional effort that favors the employed-physician model versus other models. Some experts are skeptical, however. Thought leaders, such as Tom Scully, partner at Welsh, Carson, Anderson & Stowe, commented on ACOs in a Wall Street Journal article4 as follows: The biggest flaw with ACOs is that they are driving more power to hospitals — not to doctors. Very scary, and I am a hospital guy. The goal of ACOs was to organize doctors to focus more on patients and keep the patients out of hospitals. Instead, doctors are selling practices to hospitals in droves. The start-up cost of a real ACO is probably $30 million and up in a midsize market — and doctors don't have that capital. So hospitals are pitching that they will be ACOs, and buying up practices. Ever meet a hospital administrator who wants to work to empty his beds? This means more power in expensive institutions, more consolidation of those giants — and more bricks and mortar and more costs. And with zero antitrust enforcement in the last 30 years in the hospital world, we are cruising for regional hospital-based oligopolies — not good for doctors, patients or our hopes for a more efficient system. And the well-intentioned concept of ACOs is feeding that fire. Managed care is not merely a matter of large populations (5,000 to 20,000 patients probably isn't large enough), but of subpopulations with unique health problems that require different protocols and approaches to improving their care. In the general population, the healthiest half account for a grand total of 3 percent of health costs. If those are the folks you end up worrying about in an ACO, you're wasting your time. It is the incredibly heterogeneous 5 percent of the population that generates 47 percent of all costs that you need to focus on, and if you don't have enough of them in your "attributed" population, you cannot concentrate the resources to change their care and lives. 4. Physician leadership burn out The evolution of healthcare can require new roles for physicians, from both a clinical and management perspective. It is an open question as to whether the physician community is wholly interested and/or has the energy to take on new leadership roles. Many physician organizations suffer from a shortage of physicians willing to put in significant non-clinical time toward clinic leadership. The root of this unwillingness may be that more senior physicians are somewhat burned out, or it could be that younger physicians really want a "job" instead of a leadership position in their organization. For example, one study by the Mayo Clinic in Rochester, Minn., found that "while the medical profession prepares for treating millions of patients who will be newly insured under the healthcare law...nearly 1 in 2 (45.8 percent) of the nation's doctors already suffer a symptom of burnout. 'The rates are higher than expected,' says lead author and physician Tait Shanafelt, MD. 'We expected maybe 1 out of 3. Before healthcare reform takes hold, it's a concern that those docs are already operating at the margins.'"5 11 Unhappy doctors [could] cut back their hours or retire early. In turn, that could further stress the overstretched medical system. For example, [one expert] says, it may exacerbate the country's existing doctor shortage, predicted to grow to more than 60,000 within three years, according to the Association of American Medical Colleges. The study ranked medical specialties by the percentage of doctors who are burned out — or conversely, satisfied with their jobs. Emergency doctors ranked lowest, with a burnout rate of 70 percent, while practitioners in such fields as dermatology and pediatrics were among the most content. Already, [another expert] says, prospective doctors have taken notice of older physicians in badly afflicted specialties like general surgery — which the study places last in career satisfaction — and are choosing not to enter them. "Our medical students are seeing general surgeons and primary care physicians burned out, and they don't want any part," he says. 5.  Chief executive officer concerns; ACHE study An American College of Healthcare Executive survey recently analyzed the core concerns weighing on CEOs. The top concerns, in order, included financial challenges, healthcare reform, patient safety and quality and government mandates. (See chart below). It is particularly interesting to see the growth of concern focused on quality as compared to five or 10 years ago.   Further, CEOs are concerned about labor costs, loss of procedures, less indemnity insurance, more uninsured patients and increased This burnout could have a very significant impact as explained by Chase Scheinbaum in Businessweek6: Source: www.ache.org/pubs/research/ceoissues.cfm

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