Becker's Hospital Review

63 Clinical Integration & ACOs full impact of the substantial increase in the volume of insured patients, ac- cording to a Kaiser Health News report. 13. Medical school capacity is not improving. The average acceptance rate for medical students is at 44.5 percent with some schools accepting less than 10 percent amidst a rising need for physicians all over the country. Additionally, as previously mentioned, federal budget cuts have directly affected the number of residencies hospitals are able to offer for medical students, making it impossi- ble for some students to finish their licensure. Although an increase in medical school acceptance rates may seem like a viable solution, the lack of residencies and therefore inability to continue their subsequent level of training compli- cates the ability to simply expand medical school enrollment. 14. The AMA recognizes and is attempting to address the looming shortage by implementing new policies. The American Medical Association voted June 11 to support innovative education models to address physician shortages in specialties that are undersupplied and areas that are underserved. The new pol- icy encourages federal and state governments and private payers to satisfactori- ly fund graduate medical education and increase the number of available GME slots. The policy also encourages the Accreditation Council on Graduate Medi- cal Education and the American Osteopathic Association to develop methods to train and reward physicians who are part of patient-centered care teams. 15. Nearly a quarter of physicians regret their career choice and over a third are unlikely to encourage young people to enter the field. In addition to the 23 percent of physicians who would not choose to become a physician again if they could turn back time, 21 percent of physicians said that they would not choose a healthcare profession at all. The two greatest concerns of both physicians-in-training and practicing physicians are compensation and reimbursement and a lack of work/life balance. Additionally, only 35.4 per- cent of physicians reported being "beyond satisfied" or "satisfied" with their income level and the amount of hours that they worked. Of physicians whose income decreased in the past year, 61 percent would not encourage a career in the medical field, and only 35 percent of physicians whose income increased say they are very likely to recommend a career in the field to a young person. These issues seem to be factors with regard to both the physician shortage and reports of physician burnout. Veteran care is also threatened by the physician shortage amidst the ongo- ing Department of Veterans Affairs scandal. Military or government employ- ment is listed as physicians' least favorite practice setting. The Department of Veterans Affairs is faced with only 2 percent of physicians being interested in military or government-employed practice. The VA is then forced to rely on temporary physician staffing creating more communication issues, a lack of continuity of care and discrepancies in accountability. n T he term "accountable care organization" was coined in 2006 by Elliott Fisher, MD, the director of the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, N.H. Since then, the ACO model has grown leaps and bounds as there are more than 520 ACOs in the nation, with the number growing each month. Here, three leaders from well-established ACOs share dif- ficulties they've faced and mistakes they've made to help the model's new entrants make the transition into accountable care. Note: Responses have been edited for length and clarity. Question: What's the most difficult part of leading an ACO? Lynn Barr, founder of the National Rural ACO (Nevada City, Calif.): There aren't enough hours in the day and three years goes by in the blink of an eye. It is also hard to gain the trust of the physicians, who have been burned too many times and are over-burdened. Ruth Brinkley, president and CEO of KentuckyOne Health (Louisville): I would say it was getting the IT platform to- gether and assembling the component parts. Most health systems probably have the component parts, but they are not assembled the way they need to be to advance an ACO. Aric Sharp, vice president of UnityPoint Health Partners (West Des Moines, Iowa): There is a temptation to place too much emphasis on the financial mechanism of transition- ing payment models. The vast proportion of time should be dedicated to clinical transformation. Q: What's one mistake you've made as an ACO leader that others could learn from? Lynn Barr: I wish we didn't wait until we were approved to launch the ACO. We could be three months further down the road if we launched the initiative while we were waiting for approval. Ruth Brinkley: Getting the right data and information sys- tem was a challenge. We had a couple of false starts on that before finding the right system. Aric Sharp: There have been times when we have focused on financial performance instead of clinical transformation. Q: In five years, what do you think the ACO model will look like? Where do you see the model going in five years? Lynn Barr: If we are still talking about ACOs in five years we have failed. This is a transitional model — an opportunity for us to learn and develop as centers of excellence for pop- ulation health while still getting fee-for-service. Five years from now we will be aligned with our providers and our patients, providing the best possible care at the lowest cost and all of us — our hospitals, our doctors and our patients — will be reaping the rewards. We will be highly partnered with our payers - no longer adversaries but true collabora- tive partners. Ruth Brinkley: My vision would be to really have started to impact some of the health issues facing our population. I would like to think that in five years we will have some full- risk contracts and managing lives and intervening on health issues a lot earlier. I would like to think we would have built a really strong care continuum. I don't think we'll be all the way there in five years, but we will be a lot further along than we are today. Aric Sharp: We believe in five years this value-based space will lead us to a more clinically aligned model which will allow us to actively and successfully manage risk, regardless of ownership, physician employment or place along the care continuum. n ACO Leader Roundtable: 3 Leaders on ACO Difficulties, Mistakes By Heather Punke Lynn Barr Ruth Brinkley Aric Sharp

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