Large Practices Might Evolve Into ACOs

Researchers at the Dartmouth Institute for Health Policy and Clinical Practice argue that large medical groups could be well positioned to serve as accountable care organizations (ACOs), according to an article in Health Affairs.

ACOs are provider-led, local health care delivery systems that would accept responsibility for the continuum of care for their primary care patients and have financial incentives to improve quality and reduce the costs of care.

The researchers examined the cost and quality of care delivered to fee-for-service Medicare beneficiaries in 22 markets by physicians in small group practices and in large multispecialty groups. All were members of the Council for Accountable Physician Practices (CAPP), an affiliate of the American Medical Group Association.

Overall, the large multispecialty group practices improved the quality of care by 5 percent to 15 percent at a 3.6 percent ($272) lower annual cost per patient, compared to the smaller group practices. The researchers point out that existing integrated delivery systems, multispecialty group practices, hospitals that employ their own primary care physicians, and well-established physician networks (such as some independent practice associations) are already structured in ways that would allow them to participate as ACOs. Mechanisms to help small practices establish integrated networks could be developed, allowing these smaller groups to have similar advantages.

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