Now that previously unknown details about accountable care organizations have been released in HHS' proposed regulations, many specialists can begin deciding whether they fit into this new delivery structure. Scott E. Glaser, MD, president of the Pain Specialists of Greater Chicago, thinks interventional pain management physicians could be a tremendous help to ACOs in providing high quality services at lower cost, but he wonders how his specialty would be treated.
Specifically, pain management physicians could help ACOs save money by providing more effective treatment than primary care physicians and orthopedic surgeons, who currently see most patients who have acute or chronic spinal pain, Dr. Glaser says. But advises pain management physicians to first find out if ACOs are right for them. Here he identifies six questions pain management practices should ask to make their determination.
1. Would referral patterns change? "Pain management practices have the potential of providing superior quality and cost savings in an ACO structure if they can begin treating and educating these patients from day one," Dr. Glaser says. But would hospitals, primary care physicians and others in control of ACOs be willing to alter current referral patterns? "Large organizations tend to be less willing than individuals to accept change," he observes. "Would ACOs be any different?"
2. Would more expensive therapy be rejected? Some pain management treatments, such as X-ray guided injections, are pricier than a simple office visit but quickly lead to cost savings through less surgery, fewer ED visits, decreased hospitalizations and fewer readmissions. Would the ACO push for lower initial costs and oppose these money-saving opportunities?
3. Would ACOs back up pain management? The ACO could be invaluable in encouraging more primary care physicians to accept pain management by hosting CME events and other opportunities and allowing pain management physicians to provide referring physicians with evidence showing the efficacy of their approach.
"Pain management physicians follow scientifically proven, minimally invasive treatment pathways," Dr. Glaser says. "Many primary care physicians are not aware of the excellent risk/benefit ratio and cost effectiveness of IPM procedures when performed by well trained IPM physicians."
4. Can hospitals adopt a new attitude? Hospitals are expected to lead many of the ACOs, but can they set aside their traditional bias toward admitting patients? "Hospital people are inpatient-oriented," Dr. Glaser observes. "They may pay lip service to the goals of ACOs but would they truly be interested in outpatient alternatives like interventional pain management?"
5. How would savings be shared? How would the ACO divvy up the savings from less costly patient care among the hospital, primary care physicians, other providers and specialists such as pain management physicians? What percentage of the payment would go to each one? "This issue will be vexing for all chronic conditions treated under an ACO model," Dr. Glaser observes.
6. What payment method would be used? The shared saving arrangements of Medicare ACOs, even under the new proposal for "two-sided" risk, might not provide sufficient incentive to change outdated care pathways and referral patterns. Some private payors are considering partial capitation, which would provide richer rewards for savings, but are pain physicians ready to take on such financial risk?
"This is the ultimate question — who shoulders the risk and how should they be rewarded?" Dr. Glaser says. "The ACO that can spread the risk most equitably will be the organization that succeeds."
Learn more about Pain Specialists of Greater Chicago.