Mark Lutes, a Member of the Firm in the Health Care and Life Sciences practice in the Washington, DC, office was interviewed for an article titled “Should Specialists Join ACOs?“
According to the article, as hospitals and large multispecialty group practices gear up for accountable care organizations, procedure-oriented specialists are still trying to figure out their role in them.
ACOs face the possibility of losing money by at least the third year, as part of the new “two-sided” risk model in the proposed regulations.
Lutes thinks that it would be up to the original investors in the ACO, and not specialists, to cover expenses like start-up costs and downside risk. “Losses would be covered by the original investors,” he says.
Lutes believes beneficiaries will listen. “When your primary care physician refers you somewhere,” he asks, “how many times have you refused to go?”
Since a contract is not necessary in a Medicare ACO, Lutes envisions a “dialog” between the specialist and the ACO. The specialist would be asked to help hospitals and primary care physicians that run the ACO to set up a “care path” for the integrated care of the patient, he says.
Lutes says bundled payments might be a better fit because they are linked to a particular procedure, which specialists can understand. Under a bundled payment, the hospital and specialists work together to bring down the cost of a certain procedure, such as knee implants. “The specialist might have more of an incentive to improve care with a bundled payment than under shared savings payments in an ACO,” Lutes says.