Issue link: https://beckershealthcare.uberflip.com/i/821337
84 CMO / CARE DELIVERY Almost Half of Physicians in Shared Savings ACOs Aren't Aware of Their Downside Risk By Emily Rappleye N early 50 percent of physicians participating in Medicare Shared Savings Program ACOs could be losing money without knowing it, according to a survey published in Health Affairs. The survey polled more than 1,400 physicians across three ACO models — Pioneer, MSSP and Advance Payment Mod- el — between September 2014 and April 2015. Of the 405 physicians participating in MSSP ACOs, 49.5 percent did not know if they were financially at risk by participating in the ACO. Similarly, 49.7 percent of Pioneer ACO par- ticipants were unsure of their risk and 36.5 percent of AP ACOs were unaware of their risk. Similar proportions of participating physicians didn't know if they were eligible to receive shared savings: 45.5 percent of physicians in MSSP ACOs, 47.2 percent in Pioneer ACOs and 32.9 percent in AP ACOs, according to the survey. The lack of awareness about the models may be due to the overall apathetic attitude physicians in the survey ex- pressed about ACOs. Physicians indicated they were only moderately convinced ACOs could be successful in im- proving quality and reducing costs of care, according to the survey. Physicians participating in AP ACOs were most likely to have a positive perception of the model of care and its positive effect on patient care. The authors suggest this could be linked to the type of physicians that participate in the various models — AP ACO physicians are more likely to be primary care physicians in small or rural practices. Physicians part of AP ACOs also were the most involved in the decision to join the model, according to the survey, which could influence their perception of its success. For instance, 65 percent of physicians in AP ACOs reported involvement in the decision to participate, compared to 30 percent of physicians in MSSP ACOs and 19 percent of physicians in Pioneer ACOs. "[T]he results of our survey suggest that many participating physicians' views are not aligned with ACO goals and that the physicians are divided as to whether or not the ACO model is effective," the authors wrote. And while most phy- sicians surveyed noted a general move away from fee-for- service, they didn't necessarily feel ACOs were the driver of this. "[T]these physicians seem largely comfortable with their own ability to adapt to the shift toward value-based payment and may not view the ACO model as necessary to their success in doing so," the report reads. n Icahn School of Medicine Works to Change its Academic Culture Following Dean's Letter on Student's Suicide By Alyssa Rege O fficials at New York City-based Icahn School of Medicine at Mount Sinai are on a mission to change the aca- demic and behavioral cultures at the school following the suicide of a fourth-year medical student last fall, according to e Wall Street Journal. In a letter published in e New England Journal of Medicine in March, David Muller, MD, dean of medical education at Icahn School of Med- icine, commented on the immense pressures that oen leave medical students feeling help- less and burned out. His letter was in response to the death of 27-year-old Kathryn Stascavage, a fourth-year medical student at the school who committed suicide in August. Dr. Muller, along with roughly 30 faculty members, medical students, fellows and res- idents, took part in a task force to examine and remedy various cultural aspects at the medical school. e group was split up to address three areas: mental health, physician well-being and the academic learning envi- ronment, according to the report. Dr. Muller said the school has already begun to implement one of the task force's recom- mended changes to its academic culture. e group discovered one of the leading sources of anxiety for students was the high-stakes grading system. e school had a quota sys- tem in place for each class, which limited the number of third- and fourth-year students who could obtain an "honors" or "high pass" distinction to 25 percent each. e other 50 percent would receive a "pass" grade. e system promoted intense competition among students, according to the report. Following the task force's recommendation, officials al- tered the quota system, allowing one-third of students to be eligible for each of the "hon- ors," "high pass" and "pass" distinctions. Dr. Muller said officials hope to eventually create an educational system that will drop the quo- tas all together, according to the report. Other changes the school is working to im- plement include making it easier and cheap- er for students to consult a therapist and for students to have regular mental-health check- ups, with the option to opt out. Officials are also working to allow students to take a break from their work and meet with trusted peers and faculty to discuss stressful incidents such as the death of a patient. Dr. Muller told e Wall Street Journal he hopes the tragedy will inspire significant change to the medical school culture not only at Mount Sinai, but across the U.S. "e same kind of compassion and humanism we are teaching them to show patients, they should be showing each other and we should be showing them," he said. n