August 2013

Approaching Accountable Care
By Jim Knaub
Radiology Today
Vol. 14 No. 8 P. 3

How will radiology groups fit into the world of accountable care organizations (ACOs)?

The one thing we know for certain is that any coalition of hospitals, physicians, and other providers that contracts for the care of numerous lives certainly will need to provide imaging services. You don’t have modern health care without medical imaging.

But how will radiologists fit into the ACO equation? Here are three logical possibilities:

1. As contractors: An ACO may contract with a radiology group (or groups) to provide imaging services to the ACO.

Jeff Milburn, a consultant with MGMA Health Care Consulting Group, recently told me radiology groups may want to consider the contractor route. Contracting with an ACO wouldn’t be that different from negotiating with an insurance company or health care system. The prospect of negotiating a discount on an anticipated volume of services is familiar to radiologists and may be more comfortable than entering some risk pool where the radiologists would have little effect on overall utilization. Milburn expects radiology groups to feel that pressure from hospitals to share risk in the arrangement.

2. As employees: A hospital or health system forming an ACO, or partnering in one, may employ its own radiologists.

More hospitals certainly are seeking to employ radiologists, giving hospitals more control over imaging as they move into the ACO environment. Of course, radiologists have very different views on the desirability of hospital employment.

3. As partners: A large radiology group (or radiologist partners in a large multispecialty group) could become formal partners in an ACO, fully sharing risk and reward for the care and cost of contracted patient lives.

Not participating also is an option. If you and your partners believe the ACO concept will stumble on implementation and ultimately collapse, not participating and essentially selling the idea short may prove to be a wise move. If ACOs gain traction and move forward, you and your group may need to scramble to catch up. Milburn’s concern about radiologists sharing risk in an arrangement where they have little, if any, control over utilization led him to suggest stop-loss insurance or some form of negotiated formula to limit loss. (Some of Milburn’s thoughts on physician compensation will be included in an article in next month’s issue on physician compensation.)

Milburn’s view on radiology groups wanting to be contractors to ACOs rings true to me. Successful private practice groups looking to maintain their autonomy seem likely to gravitate in that direction rather than become employees or true partners in an ACO.

The timing and speed of any ACO transition remains unclear—and a 2016 Republican presidential candidate with sizable coattails could undo it altogether—but savvy radiology groups already are considering when and how they’ll move into this realm.

Enjoy the issue.