ACO regulations raise questions of risks vs. rewards for primary care

June 10, 2011

Primary care practices are not currently required to participate in accountable care organizations, but pressure to join likely will increase because primary care physicians are central to the concept.

Primary care practices are not currently required to participate in accountable care organizations (ACOs), but pressure to join likely will increase because primary care physicians (PCPs) are central to the concept, according to an expert. "There's great excitement around the idea," says Quentin Pirkle, MD, vice president and chief medical officer of Atlanta-based Piedmont Medical Care Corp. and chairman of the board of Piedmont Clinic.

But the regulations may contain some deal-killers, too. Pirkle cautions that three aspects of the proposed regulations are worrisome to PCPs considering participation in an ACO-patient assignment, lack of data, and reimbursement issues. In addition, unlike specialists, hospitals, and labs, PCPs are only allowed to belong to one ACO at a time, limiting their options. The Centers for Medicare and Medicaid Services proposes assigning patients retroactively, based on their usage patterns, so ACOs would not know which patients they have been assigned or whose care is being monitored. Pirkle suggests that practices may have to call all the patients assigned to the ACO to learn their health status and who among them needs follow-up.