My wish list for a perfect ACO

If you believe what most people are saying about health care reform and future practice models, you or your physician, will soon be part of an accountable care organization (ACO).

Health policy experts tell us that as physicians, we’ll be embarking on a wonderful journey that bears no resemblance to the HMO/managed care heyday of the early 1990s.  Of course, there’ll be similarities, like limited networks, top down implementation of health protocols, and the assumption of financial risk for the health of your entire patient panel.  But don’t worry, the acronyms are completely different.

For those of us who are still skeptical, we ask: if there are increased financial risks for joining an ACO, what then are the rewards?  What would make me, as a physician, excited about joining an ACO (or choose one ACO over another)?  Some say we’ll have no choice to join, but I can’t help but offer a “wish list” of things my new ACO can offer to sweeten the deal:

1.  No more paperwork. Do we really need to be spending our time doing disability forms, DMV paperwork, or prior authorizations?  The appropriate staffing should be in place to make sure doctors spend less time on paperwork, and more time on coordinating care.

2.  Immediate curbside consults. I want to press a button on my computer screen, and have a cardiologist pop up instantly so I can run by a clinical question with the patient still in the room.  No appointment needed.  Good for patient, good for doctor.

3.  Binding arbitration. This is a tough one, but because we’ll be explicitly rationing care based on protocols, guidelines, and community standards, we need some process in place to protect us and our patients when those protocols fail.  Kaiser has successfully implemented binding arbitration within their system, and it might be beneficial to follow their example. Binding arbitration can lead to quicker resolution (and settlements) for both patient and doctor.

4.  Access to pain management, disability evaluation, counseling, nutrition. Our patients should have access to everything that can get them better sooner.  These services are essential for good care.

5.  A great EMR. Obvious.  The less I spend on clicking and entering, the more patients I can see/email/call.  Which brings me to …

6.  Medical scribes. Think about how much time physicians spend on documentation.  Now imagine someone else doing it.  I want a medical scribe.

7.  Emailing patients. We need dedicated time to email patients.  If your ACO doesn’t want to spend money on having them come in for a visit, they sure as heck better have a good email system in place to communicate with patients. Oh, and I want a scribe to transcribe my emails.

8.  Physician unions. Since many physicians will be salaried employees under ACO/hospital arrangements, it’s only fair that we start to unionize as our colleagues in the nursing profession have done.  This should help mitigate concerns about compensation that will undoubtedly arise.

9.  Adherence coordinators. There should be a whole department dedicated to following up on labs, imaging, and making sure that people get their chronic disease labs and cancer screenings.  It shouldn’t be left solely to the physician to remember the countless things their patients need; we tried that system and it doesn’t work.  This is a team game now, and physicians need all the help they can get.

I like to think this is a pretty realistic list.  I’m not asking for an EMR that can read our minds, or to make a million dollars a year.  I just want to make sure we’re getting something for the loss of autonomy, the limited referral network and the additional assumption of risk.

I still want to have a meaningful connection with my patients.  I want them to be healthy and happy, and have access to affordable, quality care.  I know physicians have a hard time asking for help,  but if we’re going to jump on board this grand ACO experiment, we better be vocal about the tools and resources we’ll need to take care of our patients.

Keegan Duchicela is a family physician who blogs at Primary Care Next.

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