The growth of accountable care organizations is cutting physician work hours as well as the likelihood of doctors being self-employed, according to a new JAMA report.
The study of nearly 50,000 doctors found a 10% increase in ACO enrollment in a hospital referral region is connected with 0.82 fewer work hours per week for male physicians. The 10% number is also associated with a decrease of 2% in the probability of physicians being self-employed.
The study found that older physicians were more apt to shift to employment, potentially to receive retirement benefits after selling their practices by selling their practices to hospitals.
ACOs are becoming more popular alternatives as more systems move to value-based contracting.
UnitedHealth Group, which includes the nation’s largest private payer, expects to double the size of its national accountable care organization NexusACO at least once and maybe twice through the end of next year.
The JAMA report found there were 923 ACO contracts in 2017 that covered more than 32 million people.
The question is how further ACO growth will affect physician employment and work hours. The study found hospital-controlled ACOs are hiring physicians as employees. That is reducing doctors’ incentives to work long hours.
“Although our data do not offer a mechanism that underlies these findings, well-performing ACOs may make more efficient use of physician time by shifting tasks that do not require physicians to other team members,” the study authors wrote.
Though the study showed minor reductions in hours worked, the researchers suggested doctors could reduce work further as ACOs mature.
They said older physicians moving into employment for retirement benefits could “fuel further increases in ACO employment in the short run, but in the long run could raise questions about availability of physicians in ACOs.”
Physician hours will play an even bigger role in the coming years with the expected doctor shortage. At the same time, physicians complain about feeling burnt out from their current workload, which may get worse.
Are ACOs a way to resolve that issue? The study said future research should look at physician job satisfaction for doctors in ACOs to see if those contracts lessen burnout problems. “Given the rapid increases in the numbers of primary care nurse practitioners, future research should also examine the association between ACOs and employment patterns of … nonphysician clinicians,” they wrote.
Though ACOs show potential, the reality hasn't always been positive. A recent report in Health Affairs found many innovations haven’t met promises of improving outcomes and efficiently using resources. However, ACOs present “new opportunities to develop the evidence necessary to implement, scale and sustain these needed innovations in healthcare delivery,” the authors of that study said.
Examples of ACOs finding success include CMS’ Next Generation ACO and Medicare Shared Savings Program. A 2017 report showed that 11 of 18 Next Generation ACOs earned savings in 2016. Also, the HHS Office of Inspector General found that the Medicare Shared Savings Program reduced spending and improved care quality in most ACOs during the program’s first three years.