Otolaryngologists Missing from Leadership Ranks of Accountable Care Organizations

But, if at some time in the future otolaryngologists join an ACO, then there may be internal pressure to refer within the ACO for specialty care. “This could potentially affect patient care by limiting physician options for the patient,” Dr. Eisenberg said.

Benefits depend on whether or not you’re the only specialist in town, Dr. Dupree said. If you’re the only specialist, he doesn’t think the ACO will greatly impact your practice, because most likely all of these patients already go to your practice. “But if you are in a subspecialty competitive market, participating in an ACO may give you better access to patients,” he said.

If ACOs are moving toward surgical quality metrics, then it would be wise for surgeons to have a voice. Surgeons offer a unique and important perspective on how we can improve healthcare for patients.
—James Dupree, MD, MPH

Changes on the Horizon

Looking ahead, the study researchers believe that ACOs will mature and begin to pay attention to larger cost centers when they examine their expenditures and realize how much they’re spending on surgical care. “I also think that CMS may develop more quality metrics that affect surgery,” Dr. Weissman said.

This will be a good thing, he added, because patient care provided by primary care (the referral base) and surgeons needs to be better integrated to ensure that patient voices are heard, to make the referral process more efficient, and to make sure that only appropriate patients are referred to surgeons.

At some point, Dr. Nielsen said, ACOs will look beyond primary care, because “primary care can’t do this all on its own. The help of specialists will be needed in order to continue the momentum for improvements to the healthcare system.”

If ACOs do expand and surgical care examined more closely by the governance, then Dr. Dupree believes surgeons will need or want to participate in ACOs in order to gain access to those patients. In addition, “surgeons might want to brand themselves as being part of an ACO as a reflection of quality to attract patients,” he added.

As ACOs continue to grow and prosper, Dr. Coppola believes that an otolaryngologist who wants to control his or her destiny and make decisions about the most cost-effective way to provide care and get paid better for doing that will want to be involved in ACOs. But this will vary significantly between regions.