These days, you can't turn anywhere in healthcare circles without hearing discussions of how Accountable Care Organizations are going to transform healthcare. But the truth is, nobody's sure exactly what an ACO will be when the dust settles. And for that reason, if nothing else, some providers want nothing to do with this particular healthcare acronym.
Among those who aren't fans of the concept are Dr. Gene Overholt, a gastroenterologist with Knoxville, TN-based Gastrointestinal Associates PC. Overholt does not want to see Gastrointestinal Associates join an ACO—instead, he wants to see the practice set up as the go-to team for his specialty when ACOs need help.
Healthcare Dive had a chat with Overholt about ACOs, and why he'd like his practice to avoid becoming part of one. Here's some of what he had to say.
HEALTHCARE DIVE: What do you think of the ACO business model?
DR. GENE OVERHOLT: Under many of the ACO models, specialists will, at least in part, lose the control of patient care we have today. I am not convinced at all that will lead to better quality of care. As currently proposed, our group could not in good conscience be subject to the rules of the ACO. And the economics from one ACO to another are so variable that specialists should be very wary of the financial risks. Unless things change, I don't plan to recommend to our group that we join an ACO.
Why are you skeptical about ACOs' future?
OVERHOLT: They're basically a form of HMOs, with capitation and gatekeepers. While it might work this time, it didn't work before. And [besides,] they're untried and untested in general. Our group has always been on the forefront of practice and technology change. But on this one, we will be on the side line, observing closely.
So how are you going to respond to the presence of ACOs in your marketplace?
OVERHOLT: I'm recommending that we make ourselves the go-to group by offering quality we can demonstrate, strong communication with primary care physicians and services at a lower cost than can be offered at a hospital. If we can do that the ACOs, if they are what they say they are, will come to us—and we can contract with them without joining.
How do you plan to deal with changes in reimbursement that are likely to come up—like value-based bundled payment—without an ACO partner?
OVERHOLT: We're taking advantage of the fact that we control (ambulatory surgery) facilities, anesthesia and pathology services and therefore determine quality and price ourselves. If ACOs are truly about saving money and improving care, our combination of controlling the ASC, anesthesia and pathology will be a winner for them as well as for 3rd parties and the federal government.
Furthermore, control of those elements allows us to venture into the field of bundled outpatient payments. Though it's at a very early stage, we're actively reaching out to smaller insurance companies and saying "here is our bundled rate for this procedure." We're also one of very few groups in the country that are measuring our quality and going at risk in contracting on the basis of quality. If we meet quality benchmarks—based on a national registry—we get better reimbursement. Bundling and quality come together.