January 10, 2017
Where Do Hospitalists Fit in ACOs?

Value-based care has led to restructuring of healthcare delivery models in ways that can accommodate the change from independent fee-for-services for individual patients towards a more comprehensive patient care that encompasses overall patient health for a longer span of time. Indeed, the development of accountable care organizations (ACOs), whether hospital-based or physician group-based, are already showing promising results in the arena of value-based care, with an average $12 million in savings and improved inpatient care from an 18-month report released by the Centers for Medicare and Medicaid Services (CMS).

However, this emphasis on value over volume and development of ACOs employs care strategies that are largely carried out by over-arching structures and policies, rather than how individual providers work on the front lines to improve the overall progress of health (and not just a specific care incident). Unlike the physicians in independent practices who come together to form groups and can mold individual practice around reducing costs within the system, hospitalists within the hospital-based ACO setting are in a unique position that requires them to address patient care, with perhaps less control over the financial needs of the hospital where he or she is based. Given the current ACO trends that will impact the way in which healthcare is delivered, hospitals will have to think about how they support hospitalists, so that they can better deliver on the quality and cost aims their ACO seeks to achieve.

Quality assurance through performance-measures

Hospitalists can expect greater scrutiny in their performance within the set-up of an ACO and “higher percentages of their revenue tied to performance metrics.” This oversight aims to control for quality care that, in the end, results in overall cost-efficiency. Quality-based metrics are then used to evaluate parameters of hospital care that can influence patient outcomes, and subsequently, also hospital expenses. These variables include rate of readmissions, hospital and ER utilization, the extent of communication with post-acute healthcare providers for the transition phase, and patient satisfaction, among others.

Increased focus on efficiency and financial impact

As briefly mentioned, the hospitalist is a crucial, central figure in a hospital-based ACO healthcare model because he or she stands as the bridge between patient care and hospital expenses. The careful decisions and actions the hospitalist makes on behalf of a patient’s care have an impact on the costs that must be sustained by the hospital. Because of this, hospitalists must become much more sensitized to the effects that treatment options and medical actions have on costs. They must take on a more active role in assessing and striking a balance between high-quality care and financial risk, and not let the financial aspect of an ACO be the sole responsibility of hospital administration, since financial decisions can also have a reciprocal impact on how they can work.

Leveraging aspects of the system to create high quality and low cost

A thorough understanding of the aspects of an ACO that promote efficient and effective care, while accounting for financial factors, is vital for the smooth operation of an ACO. Hospitalists should recognize the importance of teamwork and increased coordination within the various subsectors of a hospital and, indeed, may be the central provider in achieving these goals. A smooth transition from the hospital setting to post-acute care also improves overall patient recovery and enhances the quality of care that can be measured (i.e. thorough understanding of a patient’s condition by the post-acute provider via clear documentation and communication of the needs of the patient in the acute hospital phase can reduce the incidence of unnecessary hospital readmissions). This coordination is also recognized in the Accountable Care Guide for Hospitalists as the single most important element in a successful ACO.

Recognition and adaption of the necessary elements for success in the ACO model can help hospitalists and the hospital function in ways that provide improved quality care to patients and result in healthy financial costs.