Survey: Forming an ACO ultimately is a people problem

June 29, 2011

Lack of capital, integrated systems and evidence-based treatment protocol data all play into the difficulty of creating an accountable care organization (ACO).The biggest challenge, however, is a personnel issue, and how physicians and hospitals will work together to resolve it.

Lack of capital, integrated systems, and evidence-based treatment protocol data all play into the difficulty of creating an accountable care organization (ACO).

The biggest challenge, however, is a personnel issue, according to a new survey from AMN Healthcare, the nation’s largest healthcare staffing and workforce solutions organization.

Of the survey respondents-882 administrators and physicians-nearly 60% indicated that their facilities either are in the process of forming ACOs, or are considering doing so, while slightly more than 40% reported that their facility have no plans to create ACOs in the foreseeable future.

The “people issues,” defined as “physician/staffing alignment’” were the biggest issue for both groups.

Of those in the process of adopting ACOs, 42% said physician alignment is the most serious obstacle they face, followed by lack of capital (38%), lack of integrated IT systems (31%), and lack of evidence-based treatment protocol data (25%). Almost 40% of those who are not moving toward an ACO cited physician alignment as the deal breaker, followed by lack of capital (31%), lack of integrated information technology  systems (26%), and lack of evidence-based treatment protocol data (23%).

The problem is that physician practices and hospitals have rarely been on the same page on many issues, including patient care, costs, reimbursement, and governance. Yet they would have to work together to create an ACO without clear guidelines on who would head the organization, how risk would be shared, and how everyone would get paid.

Even if those issues could be resolved, it is not at all clear that with the worsening shortage of primary care physicians, hospitals would be able to staff up to meet federal ACO requirements.

"While capital and data are essential to forming ACOs, the success of this emerging model turns on people. Health facility leaders and physicians must align their interests, communicate and cooperate for this model to work," Susan Salka, AMN Healthcare president and chief executive officer, says about the survey.

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