What are the short-term effects of formal reform?
OBG Management: What effect has health-care reform had so far?
Ms. DiVenere: In 2010, twice as many physician practices were bought by hospitals and health systems as in 2009. We can’t conclude that the 2010 law is responsible for these changes, but we know that the architects of health reform were aware of this trend, believed it was beneficial, and looked for ways to encourage it, including through development of accountable care organizations (ACOs), which give hospitals a new and potentially lucrative reason to purchase private practices.
OBG Management: What exactly is an ACO?
Ms. DiVenere: An ACO consists of aligned providers—most likely, large multispecialty groups, often affiliated with the same hospital—who agree to manage patients for a set fee, sharing the risk and potential profit. ACOs are required to have shared governance, which gives them the authority to impose standards for practice, reporting, and compensation—including rewards and penalties—across a group of physicians.
Each ACO must sign a 3-year contract with the US Department of Health and Human Services (HHS) and include a sufficient number of primary care professionals to care for at least 5,000 beneficiaries. ACOs will be evaluated by quality-performance measures to be determined by the Secretary of HHS.
What aspects of ACA will have the biggest impact?
OBG Management: What provision of the new law will have the most direct impact on ObGyns in private practice?
Ms. DiVenere: All ObGyns may benefit from the guarantee of insurance coverage for our patients for maternity and preventive care. And all ObGyns should join ACOG’s fight to repeal the Independent Payment Advisory Board, which may hold enormous power to cut physician reimbursement.
Here’s the quote all ObGyns—especially those in private practice—should read, from an article written by President Obama’s health-reform deputies:
To realize the full benefits of the Affordable Care Act, physicians will need to embrace rather than resist change. The economic forces put in motion by the Act are likely to lead to vertical organization of providers and accelerate physician employment by hospitals and aggregation into larger physician groups. The most successful physicians will be those who most effectively collaborate with other providers to improve outcomes, care productivity, and patient experience.6
OBG Management: Do these health-reform deputies offer any concrete vision of how this change will be achieved?
Ms. DiVenere: They detail what physicians need to do, and how they should change the way they practice, under the Act. For example, to meet the increasing demand for health care, they recommend that practices:
- “Redesign care to include a team of nonphysician providers, such as nurse practitioners, physician assistants, care coordinators, and dieticians”
- “Develop approaches to engage and monitor patients outside of the office.”6
And to meet the requirements for payment reform, information transparency, and quality, they suggest that practices:
- “Focus care around exceptional patient experience and shared clinical outcome goals”
- “Engage in shared decision-making discussions regarding treatment goals and approaches”
- “Proactively manage preventive care”
- “Establish teams to take part in bundled payments and incentive programs”
- “Expand use of electronic health records”
- “Collaborate with hospitals to dramatically reduce readmissions and hospital-acquired infections”
- “Incorporate patient-centered outcomes research to tailor care.”6
To capture value, the authors recommend that practices “redesign medical office processes to capture savings from administrative simplification.”6
OBG Management: Do they propose any method for implementing these changes?
Ms. DiVenere: The White House is hoping that ACOs can lead. Medicare ACOs will attempt to accomplish these changes by managing hospital and physician services, prompting physicians and hospitals to change how they are both clinically organized and paid for services—this change, in particular, is considered by some to be essential to improving the quality and efficiency of health care.
The new Centers for Medicaid and Medicare Services (CMS) Innovation Center, created by the ACA, is given broad authority to test, evaluate, and adopt systems that foster patient-centered care, improve quality, and contain the costs of Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). The law specifically guides the Innovation Center to look for ways to encourage physicians to transition from fee-for-service to salary-based payment.
We can safely assume that the experts behind these provisions believe that large, hospital-centered systems or large, physician-led groups can better serve the needs of patients and our health-care system in general than can small private practices. Today, 24% of ObGyns run solo practices, and 27% are in single-specialty practices. Health-care reform can mean big changes for them.
Is the EHR a realistic goal for private practices?
OBG Management: How does the push for EHRs affect physicians in private practice?