Hospital/physician relations

Medicare's ACOs have had mixed early outcomes, but some commercial accountable care ventures, including PPO plans, are showing promise.

Healthcare reform and the shift toward value instead of volume underscore the importance of population health management for improving patient outcomes on a large scale. One essential component of a comprehensive population health program is patient access.

Accountable Care Organizations have given little attention to surgery in the early years of the Medicare program, choosing to focus instead on managing chronic conditions and reducing hospital readmissions. But ACOs will likely shift their focus to surgery as programs mature.

A new study provides even more evidence that physician leadership is the key to success with accountable care organizations. Strong focus on patient needs is a key driver of success, but physician-led ACOs typically struggle with the care coordination piece.

New research suggests that accountable care organizations should make payments to patient-centered medical homes or take other steps to support them financially, since their goals are similarly transformative.

Medicare's accountable care organizations have gotten off to a mixed start, with hospital-led ACOs especially reporting financial challenges. By contrast, physician-led ACOs may have built-in advantages, and could be a new source of competition.

The increased dependence on non-physician providers raises important questions for hiring managers at healthcare organizations. How to best utilize non-physician providers? Which roles are ideal -- e.g., nurse practitioners or PAs? And what are the financial and operational benefits?

The Federal Trade Commission's blocking of hospital and physician practice mergers, as a way to purportedly prevent monopolies, is hurting the very people the FTC claims to be helping -- the patients themselves.

Bundled payments represent a new and increasingly accepted form of reimbursement. They can work now, if applied in modest, manageable ways from which lessons can be learned and applied more broadly later.

Hospital ownership of physician practices appears to lead to statistically and economically significant increases in hospital prices and spending, according to a recent study published in Health Affairs. But that doesn't mean providers should retreat from integration and tighter alignment.