Becker's Hospital Review

Clinical Integration & ACOs 3 Factors Associated With ACO Formation By Heather Punke T here are three main factors associated with formation of accountable care organizations, be they Medicare or privatepayer ACOs, according to a new RAND Corporation study published in Health Affairs. Researchers analyzed 148 Medicare and 77 private-payer ACOs. In the analysis, they found the following three factors to be associated with ACO formation: • Physicians practicing in large groups • A greater fraction of hospital risk-sharing  • Larger integrated hospital systems Other factors, like area income, hospital concentration and high per capita Medicare spending, were not found to be associated with ACO formation. ACO formation varies widely in terms of geographic distribution as well, the study found. The Northeast and Midwest areas have many ACOs, while the Northwest lags behind in ACO proliferation. n 23 Study: PatientCentered Medical Homes Have Higher Operating Costs, Revenues By Heather Punke P hysician practices that have become patient-centered medical homes reported higher operating costs compared with non-PCMH practices, according to the Medical Group Management Association's "Cost Survey for Primary Care Practices: 2013 Report Based on 2012 Data." The higher operating costs can be attributed to the greater number of providers and staff that a PCMH need in order to be efficient and successful, according to a news release. In the survey, PCMHs had a median of 29 full-time-equivalent support staff members per 10,000 patients, while nonPCMH practices had 18.5 total support staff FTEs for the same number of patients. PCMH practices also reported higher total medical revenue per patient than practices that are not a PCMH, according to the survey data. The survey includes data on 969 total groups. n Study: 5 Drivers of Physician Satisfaction By Heather Punke W hen physicians are able to provide high-quality care to their patients, they are more likely to be satisfied, according to a new  RAND Corporation  study sponsored by the American Medical Association. In fact, the ability to provide top-notch care is a primary driver of physician job satisfaction — and when physicians perceive obstacles to providing the best care possible, they are more likely to be dissatisfied. The following are other key factors contributing to physician satisfaction, according to the study: •  Autonomy and work control.  When physicians had control over the pace and content of their practice, they were more likely to be satisfied, the study found. To that end, physicians in physician-owned practices were more likely to be satisfied than physicians in a practice owned by a hospital or another corporate entity. •  Practice leadership.  This factor's influence on physician satisfaction was two-fold. First, physicians were more likely to be satisfied when their values were well-aligned with their leaders' values. Second, when leadership took a balanced approach to new initiatives affecting the entire practice, physicians were more likely to be satisfied. •  Collegiality, fairness and respect.  Physicians with frequent meetings with colleagues and other health professionals were more likely to report being satisfied with their work.. "When physicians perceive obstacles to providing the best care possible, they are more likely to be dissatisfied." • Work content. Generally, physicians were happier when performing at the top of their license instead of doing jobs that could be done by others. Fittingly, then, having quality allied health professionals and support staff were tied to greater physician satisfaction. Results from the study are based on information from 30 physician practices in six states. Additionally, researchers conducted interviews with 220 physicians, medical administrators and allied health professionals. n

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