We’ve Seen This Movie Before
Curtis PickelleI know many radiologists who are trying—desperately, in some cases—to see how their group practices can fit neatly within what will eventually be defined as accountable-care organizations (ACOs). I say eventually because I have seen no true outline of how an ACO will work in real time, in the real world, or in any organization with which I have come in contact. I take that back: If the Mayo Clinic or the Cleveland Clinic were to declare itself the definitive ACO model, then perhaps I have seen one up close. The point is that unless you are one of these or part of a similar clinic, vertically integrated health system, or multidisciplinary group practice, it is pretty difficult to envision how your group practice could be classified as an ACO, as the concept is currently being defined. Ultimately, the government, as is always the case, will add to the already mind-bending complexity of the basic idea of a provider taking ultimate responsibility (and risk) for the complete health care of individual patients. It is a good and noble idea. It is worthy of discussion as to how to accomplish best the bringing together of different physician specialists to care for the whole patient. It even makes financial sense to find a way to cross over turf lines to find a better way to spend the health-care dollar to the benefit of the patient. What is being proposed, however, will not work, I am afraid. It has been tried and tried in previous iterations—HMOs, managed care, capitation, and so on. This is the new–old model: It is intended to rein in costs, but in doing so, it forms new bureaucracies that add to the overall cost of the system, it creates perverse incentives to deny or ration care, or it results in a host of unintended consequences that have an overwhelming impact on those in medical practices. Think HIPAA: a good idea gone bad, full of unintended consequences and bureaucracy. Before you delve too far into the current confusion that is described as accountable care, be advised that the concept is full of pitfalls for radiology groups, particularly because the complex formula for qualifying as an ACO eventually results in the assumption of financial risk, if certain parameters are not met and if commitments fall short of expectations. The fine print is full of risk. Beyond this caution is one more: There really is no silver bullet out there that will be the savior for radiology practices that are experiencing zero growth or seeing their business erode due to a lack of urgency being placed on business development over the past couple of years. Attaching the practice to some mythical ACO will not be a panacea—and in fact, there is no panacea to be found, beyond creative, responsive, energetic, and committed partners who are all pulling the practice in the same direction, with the same sense of urgency. Practice building is hard work, and is everyone’s responsibility within the group. Hoping that becoming an ACO (whatever that is) will save you from this effort and put you squarely in the midst of the new, best, and greatest thing is like seeing a movie that you have seen a dozen times. Do you really expect a different ending? Curtis Kauffman-Pickelle is publisher of ImagingBiz.com and Radiology Business Journal, and is a 30-year veteran of the medical-imaging industry. He welcomes your comments at ckp@imagingbiz.com.