Eyeing the ACO: Demonstrating Engagement and Appropriateness

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Alan KayeAs health systems around the country initiate conversations with various constituents about becoming accountable-care organizations (ACOs), consternation in the radiology community continues over exactly what participation from practices might look like. Alan Kaye, MD, CEO of Advanced Radiology Consultants (Fairfield, Connecticut), says, “Almost every hospital is thinking about becoming the nidus of an ACO, and so are a lot of physician-run entities. It has generated a fair amount of interest, so we have to be involved in helping to fashion the appropriate structure and processes to make sure utilization is appropriate. That will bring tremendous value to the organization.” Unfortunately, early radiology practice experiences with bundled payment models aren’t particularly revealing about what might be in store when the ACO model becomes more widespread. Philip Russell, CEO of South Texas Radiology Associates in San Antonio, notes that his practice’s participation in the CMS Acute Care Episode Demonstration was fairly cut and dried. “There was no difference for us,” he reports. “The patient got an exam, the radiologist did his or her work, and we sent a bill to Medicare. The level of service activity was generally confined to radiographs of the chest and extremities, and those kinds of activities really limit themselves, with regard to the radiologist’s role.” Demonstrating Engagement Despite the lack of early information about ACOs, Kaye is very clear about the importance of being prepared for the new payment/delivery model, which has as its key goals lower costs, better quality of care, more clinical cooperation, and greater patient engagement. Stressing that he is not necessarily sure about the long-term viability of the model, he nonetheless believes it is not to be ignored and will be a factor in the short term. “If the terms are appropriate, my practice will participate in multiple ACOs,” he says. “I’m not bullish on the concept, but I am realistic. I have to make sure I cover my bases.” For Kaye’s practice, preparation for greater patient engagement has consisted of initiatives that were already underway. “My practice is an early adopter of the meaningful-use program, and through that, we have a patient portal that has become very active, so our patients now know who we are and what we do. We know how many patients sign up for it and access it. It’s a new concept for them, so sometimes, we have to educate them about what it is, but we are getting over 150 patients a week signed up now, and more than 150 patients are accessing their reports each week,” he explains. The practice also monitors its patient-satisfaction levels using the Press Ganey survey. “We have extremely high scores—which, I think, is something that will present us as a good partner for an ACO,” Kaye says. “A lot of this was not necessarily done with ACOs in mind. It’s just among the tenets of running a good practice: You want to be a preferred partner, and those parameters for an ACO are the same as those through which referring physicians and patients choose to come to you.” Taking Shape When it comes to how ACO models will take shape in his community and nationwide, Kaye is uncertain whether hospitals or physician groups will have more skin in the game. “Physicians feel that they are the ones in the best position to affect utilization,” he observes. “Hospitals, on the other hand, feel that they have the administrative know-how and are probably the largest cost center in the health care system, so they feel they have the ability to have that effect.” Utilization, indeed, will be key to the goals of cost reduction and clinician cooperation, and it is in this area that Kaye anticipates that radiology practices will have the most work to do. “One of radiologists’ most important tasks will be to become more involved in the appropriateness of the examinations that are requested,” he says. “ACOs will strive to make changes in the way we do things. From the patients’ point of view, there are potential ambiguities. On one hand, it’s great—they get the right exam for the right indication. On the flip side, however, from their perspective, it may seem that their physicians are being paid not to do something, and that is a major departure from business as usual.” With that in mind, radiology practices (contrary to popular belief), “have a lot of opportunities to connect with the patient better,” Kaye says. He points to screening modalities as particularly pivotal to making this change possible. “We can apply the model we have with mammography with some of the others—CT colonography, lung-cancer screening, and coronary screening,” he says. “That will move us up the food chain, in terms of what we bring to the table, and patients will begin to appreciate who we are and what we do more.” That participation in the care continuum will pay dividends for radiology practices seeking a seat at the ACO table, Kaye predicts. “We have to show our value to the ACO,” he concludes. “We need to demonstrate that we can help further its goals, if we do participate. If we do that, and demonstrate radiologists’ historical political and business acumen, ACOs will welcome us in leadership roles.” Cat Vasko is editor of RadAnalytics and associate editor of Radiology Business Journal.