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Otolaryngologists Missing from Leadership Ranks of Accountable Care Organizations

by Karen Appold •

As an associate clinical professor of medicine at Tufts University School of Medicine in Boston, Dr. Coppola was involved in an ACO for five years. “It was not unusual for an ACO to look at otitis media in the pediatric population and gather a panel of pediatricians, primary care providers, and otolaryngologists to come up with a consensus agreement as to how that organization will deal with guidelines for otitis,” he said. For instance, would it require antibiotics, or would the patient require an ear, nose, and throat evaluation?

“But, in many communities, this hasn’t happened yet,” Dr. Coppola added. “In most of the United States, ACOs are still in the very early planning stages. In the future, short of a one-payer system, I think this model will show that if we give financial responsibility to the caregivers, we will wind up having a better healthcare delivery system for providers and patients.”

The bottom line, said Dr. Nielsen, is that otolaryngologists are not homogeneous. “Just because an ACO is not a feasible option for me doesn’t mean it isn’t a great option for another. Plus, at this point, there isn’t enough feedback about specialty care within ACOs to determine the impact.”

Karen Appold is a freelance medical writer based in Pennsylvania.

Challenges in Creating an ACO

Creating an accountable care organization (ACO) requires significant preparation and planning. “Upfront costs for the systems needed to interact with various members of the ACO are high, and requirements to meet the patient population needs can be difficult for providers,” said David R. Nielsen, MD, executive vice president and CEO of the American Academy of Otolaryngology–Head and Neck Surgery.

An unintended negative consequence of ACOs can be a focus on short-term costs at the expense of long-term savings because there may be pressure to limit care inappropriately, which may restrict access to innovative technologies, Dr. Nielsen said.

Another challenge is the limited quality measures available for specialties like otolaryngology. “However, we are working to increase the number of such measures,” Dr. Nielsen said. “It is also uncertain what the impact on cost savings and efficiency of care would be for available otolaryngology measures.”

Lastly, the incentives are uncertain and potentially perverse. “A minimum total savings level must be reached to get a shared savings payment,” Dr. Nielsen explained. “That payment can be reduced if quality thresholds aren’t met, even when those quality thresholds are related to where the savings occurred.”