Practice Matters

News from Lola Butcher about health policy and practice management issues of importance to oncologists

Monday, January 3, 2011

Accountable Care for Oncologists: What to Do Now

Happy new year! This will be an important year for all oncology practices, and I am excited about the big changes ahead.


We will hear a lot about the term “accountable care organization,” or ACO, this year for two reasons:

  • Medicare will begin contracting with ACOs in January 2012.
  • Many health systems -- and some physician groups -- are creating ACOs so they can contract with private payers and be ready for the Medicare opportunity a year from now.
So what is an ACO? As I said in a recent OT article, the term “ACO” was coined by Elliott Fisher, MD, Director of the Dartmouth Institute for Health Policy and Clinical Practice, to describe a concept in which networks of physicians and other health care providers work together to improve the quality of care and reduce costs for a defined group of patients.

The Centers for Medicare & Medicaid Services will come up with a more specific definition for the term in the next few weeks when it publishes its proposed ACO regulations. Private payers, however, may use a different definition.


Do not allow yourself to get frustrated with the uncertainty over definitions, because the big picture of where we are headed is very clear: The marketplace for health care services is moving toward “accountability.”


That means oncologists who can prove they are providing excellent care for their patients and not wasting money on unnecessary tests and therapies will make more money than those who cannot. This is great news for some oncologists and extremely troubling for others.


This also means that the exact definition of an ACO is less important than your attitude about being accountable. I like how

Katherine Schneider, MD, Vice President of Health Engagement at AtlantiCare, described this to me:


“Accountable care is not a project, and it’s not an entity. It’s really a transformation of the way that we do business,” she said.  “It’s moving from transactions within our health delivery system  to relationships with members of our community over time and being accountable for patient outcomes over time.”

Dr. Schneider spoke to me on Dec. 17, the day after she and other AtlantiCare executives accepted one of the top awards in health care, the Malcolm Baldrige National Quality Award.

If a top performer like AtlantiCare is transforming itself, everybody else in the industry needs to be paying attention to why and how.


Dr. Schneider described the “why”-- “It’s not about the Medicare thing, and it’s not about a contracting entity, although those are important components,” she said. “This is really about how we view the future of health care in this country.”


So “how” do physicians become “accountable?” Tomorrow I will write about a good first step.