Gastroenterologists & ACOs: In or out?

Patrick TakahashiThere are more than 270 accountable care organizations in the United States. Nearly a quarter, 24 percent, of gastroenterologists are participating in ACOs, while 12 percent are planning on participating within the next year, according to a Medscape report. What should gastroenterologists consider when deciding whether or not to join?

Ask a Gastroenterologist is a weekly series of questions posed to GI physicians around the country on business and clinical issues affecting the field of gastroenterology. We invite all gastroenterologists to submit responses. Next week's question: How can gastroenterologists improve efficiency in their practices without sacrificing quality?

Please submit responses to Carrie Pallardy at by Thursday, October 9, at 5 p.m. CST.

Patrick Takahashi, MD, CMIO and Chief of Gastroenterology Section of St. Vincent Medical Center (Los Angeles): We are entering a gray zone when it comes to the question of accountable care organizations. This model for healthcare is starting to get traction in various parts of the country. As they say, the proof is in the pudding, or details in this case. All ACOs are definitely not created equal.

For a gastroenterology group, it is important to understand the specific types of ACOs that are out there. Both hospital/insurance owned ACOs versus physician-owned ACOs can be productive. However, the distribution of funds may be quite different, of course depending on costs allocated to administration personnel and the like. There is currently no regulation governing how funds are utilized from one ACO to the next. One group of physicians may receive in inordinate amount of reimbursement as compared to another group. It behooves a physician group to negotiate the best possible contract for themselves. In addition, specialists are entitled to join multiple ACOs and this option should be seriously considered.

Physicians must also ask themselves if they are being offered any ownership interest, as this may also influence their decision to join a particular ACO. In addition, one ACO does not fit all. If the standards set by the ACO are not in alignment with your own group's principals, there will be potential friction when it comes to deciding upon the type of care that will be rendered for patients. It is important to understand and be aware of the local climate around you in regards to healthcare prior to making the decision to join an ACO. There is no doubt that some physical and demographic areas will be better poised to succeed than others.  

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