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Hospitalists’ Potential Impact in Accountable Care Organizations

The rise of Accountable Care Organizations (ACOs), a group of healthcare providers who are answerable for the overall care of patients assigned to them, inclusive of quality and cost, accelerated as a result of the Affordable Care Act. In September CMS announced quality and financial performance results for the 18-month reporting period showing that 53 of 204 Medicare Share Savings Program ACOs saved $12 million on average while improving inpatient care, proving that ACOs are an innovative way to reduce costs and enhance quality. The savings of $636 million will be split 50/50 between CMS and the ACOs that reached their targets.

Respondents to SHM’s 2014 State of Hospital Medicine report indicate that nearly 36% of respondent HM groups (HMGs) nationwide worked at a hospital that was either already involved in or was contemplating involvement in an ACO. Academic HMGs were more likely to be involved (55.8%) than nonacademic groups (30.3%). The driving force behind everything we as hospitalists do is consistent with the principles of an ACO, which are to provide high quality, cost-effective healthcare that improves the health and well-being of our patients and communities.

36% of respondent HMGs work at hospitals that are involved in or contemplating an ACO.

With that said, there is a need for hospitalists to embrace innovative processes and relationships both within the hospital and throughout the continuum of care. This includes taking a fresh look at mechanisms to improve quality and customer satisfaction with a positive impact on cost. At WellStar, we have focused on implementing a number of tactical approaches aimed at transforming care delivery in multiple arenas. Key initiatives our hospitalists have been involved in include:

  • Keen focus on management optimization of observation units;
  • Establishment of an accountable care unit, where HM patients are co-located, and real-time, multidisciplinary, team-based bedside care is delivered;
  • Concerted efforts to improve transitions of care to home and post-acute care settings by providing not only follow-up appointments but also an avenue for patients to ask questions and get answers post-discharge;
  • Developing post-acute network partnerships that allow for insight into the care delivery models used at area nursing homes, long-term acute care facilities, and hospice; and
  • Creating meaningful participation in the co-management of surgical patients through participation in the pre-admission testing process.

These innovations clearly demonstrate the value of hospital medicine in the new environment of accountable care. And, while there is a great deal of effort behind each of these initiatives, the payoff has a strong impact on the organization and the community.

Dr. Akopov is vice president and chief of hospital medicine operations at WellStar Health System in Atlanta, Ga., and serves as chair of the WellStar Health Network ACO. Ms. Papetti is assistant vice president of WellStar Medical Group in Atlanta and a member of SHM’s Practice Analysis Committee.

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