6 Things to Know About Spine Surgeon Involvement in ACOs

Jeff Leland, managing director of Blue Chip Surgical Center Partners, explains six things to know about how spine surgeons might fit into accountable care organizations.

1. Don't spend a lot of time on ACOs yet. Stay tuned. Proposed federal regulations are due by the end of the year and even then, a lot of details will still need to be worked out. "Some organizations are spending a lot of money sending their people to meetings all over the country on this," Mr. Leland says. "But it's too early to dig into this topic because there is no clarity yet."

2. ACOs don't have to be hospital-centric. Although hospitals are rushing to build ACOs, groups of physicians are in a great position to lead these new organizations. Since physicians make the healthcare decisions, it makes good sense to put them at the center. However, many practices seem unprepared to take leadership and they may end up surrendering the field to hospitals.

3. Specialists should be able to form ACOs. Discussions about physicians' role in ACOs have focused on primary care physicians, but there is no reason why specialists can't form their own single-specialty ACO. For example, 12 percent of patients present to primary care physicians with back pain. Taking responsibility for managing back pain and for the financial risk of patients with back pain would place spine surgeons at the top of the "food chain" when shared savings payments are parceled out to ACOs, Mr. Leland says.

4. Practices will need to organize into IPAs. Even the largest group of spine surgeons in the country wouldn't be big enough to run an IPA, Mr. Leland says. A Medicare IPA needs at least 5,000 beneficiaries in it. This means many small physician groups will need to organize themselves into large independent practice associations, where they would be allowed to maintain their independence but they could share financial and clinical information.

5. ACOs need to have a data system. A sophisticated data-management system is important because an ACO will have to be able to manage metrics in order to follow patients, introduce efficiencies and report results to payors. ACOs will also need to demonstrate how they will manage care and reach quality goals.

6. ASCs won't lead ACOs. Spine-focused ambulatory surgery centers would function as one place where spine surgeons in an ACO could refer patients. But as the low-cost, high-quality and easy-access option for surgery, ASCs should have a bright future under ACOs.