ACOs require advance planning


How to be active in an ACO and preserve an existing specialist support network.

Q: Our hospital is forming an accountable care organization (ACO). We have some experience with this because we once were involved with capitation arrangements, and we realize that ACOs may have some similar implications. Over the years, we have developed strong relationships with our specialists and, of course, we want to maintain them. Is there any way that we can be active in the new ACO and preserve our existing specialist support network?

A: It sounds as if this process is, like most ACO processes, somewhat early in the planning phase. Certainly, the idea of "accountable care" and organizations dedicated to providing that care will be here in some form whether a major health care transformation occurs in this country. You are correct that many of the features of capitated contracts may become relevant again in the new world of ACOs. It will be important for primary care physicians to be intimately involved in the channeling of care to predetermined specialists.

If you have a group of specialists that is important to you and your patients, you should begin now to integrate your information exchanges more closely and to formalize mutually dependent quality measures, including measures of patient satisfaction. The contracting process and the provider selection process will be formed around primary care physicians who "get it" and their specialist colleagues who are committed to efficient and effective care.

Some specific ideas: (1) make sure the medical records for both practices are compatible; (2) have agreed-on protocols for imaging, labs, diagnostics, etc.; (3) have reviews of patient care protocols, and develop a continuous quality improvement process for both care and services; (4) establish access protocols to ensure timely service and coordinate related call coverages; and (5) develop coordinated patient education and informed consent materials.

Answers to readers' questions were provided by Alice G. Gosfield, JD, Alice G. Gosfield and Associates, Philadelphia, Pennsylvania and A. Michael La Penna, The La Penna Group Inc., Grand Rapids, Michigan. Send your practice management questions to

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