A hospitalist who works for one of the 32 organizations tapped in the inaugural cohort of Pioneer Accountable Care Organizations (ACOs) says HM should not expect major change in the short term from the new coordinated care model. But change will come in the long term.
"As we start to get data back and start to figure out where we can make the biggest positive impact on improving health for patients and also the impact of cost savings, then the hospitalist will be more involved," says Tierza Stephan, MD, FACP, SFHM, district medical director for hospitalists at Allina Hospitals & Clinics of Minneapolis.
The Pioneer designation was a Centers for Medicare & Medicaid Services (CMS) Innovation Center initiative crafted last summer for organizations and providers already experienced in providing coordinated care. A related model, the Medicare Shared Savings Program, does not require any previous experience with such contracts. The models set benchmarks for providers and institutions to qualify for shared shavings.
Dr. Stephan, a member of SHM's Practice Analysis Committee, helped the Allina Integrated Medical (AIM) Network become one of the Pioneer ACOs. The network includes 1,100 Allina doctors and 900 independent physicians from private clinics or practices. She says Allina has spent months preparing for the ACO: crafting its initial quality metrics, including generic drug utilization, timely turnaround of critical results, and patient satisfaction.
While all members of the network will share data to achieve better efficiency and cost savings, Dr. Stephan says it's too early in the process to say how well the program will work in practice. In the short term, she expects little daily change for HM physicians. Given the time it takes to get a program started, Dr. Stephan urges HM group leaders working on building an ACO, or those already in an approved program, to be a loud voice during the process.
"We're the primary care in the hospital, and primary care is really at the heart of accountable-care organizations," she says. "It really takes commitment by the entire healthcare community, and hospitalists interact with the entire healthcare community."