Preparing for ACO Pressures

You may soon find yourself working with ACOs. Here’s some things to know.

By John Hovanesian, MD, FACS, Irvine, CA

More than most medical specialties, ophthalmic practices can resist requests for reduced rates from payers and Accountable Care Organizations (ACOs). But it takes hard work and dedication on both the clinical and administrative sides of the business.

Patients Assume Clinical Excellence

Most patients referred to ophthalmologists believe they are entering one of the most complex and demanding specialties in medicine. So they appropriately expect top-notch treatment. If they detect anything less than superior clinical excellence and a highly trained and genuine focus on their ocular issues from everyone in the office, they’re likely to leave and try another practice.

So, let’s assume we’re all at the top of our game; we know our ophthalmic medicine and we stay on top of the latest clinical technologies and procedures. It’s how we operate our practices that influence patients’ trust in us in the new age of healthcare reform.

ACOs Building Momentum

The broad shift away from fee-for-service to fee-for-value may now be unstoppable. In particular, Medicare will probably start delivering many more patients to us through Accountable Care Organizations (ACOs).

Earlier this year, the Centers for Medicare & Medicaid Services (CMS) announced its Bundled Payments for Care Improvement (BPCI) Initiative and the more than 500 healthcare organizations selected to participate. While no ophthalmic procedures are part of the Diagnosis Related Groups (DRGs) included in the first 48 bundles participants can choose from, the scope of the BPCI Initiative is quite broad and represents only a starting point for CMS to pursue demonstrated quality and more coordinated care at less of an expense.

A Shift for Ophthalmology Practices

Generally speaking, ACOs are not going to include specialist practices. In our practice, Harvard Eye Associates in Laguna Hills, CA, we’ll continue to be contracted by hospitals and hospital systems and in contract relationships with insurance carriers. But potentially our contracts will be more with ACOs connected to hospitals than directly with insurance carriers.

When I’m asked what ophthalmologists and their staff should do to prepare for the brave new world of ACOs and new reimbursement models I recommend three things:

1. Know what you’re worth. Often, ophthalmology practices have a reputation and value to the community that goes beyond what an ACO or an insurance carrier may see. Don’t sell yourself short.

2. Cut waste and gain greater efficiencies. (More about that, below)

3. Delve into and offer premium services to your patients. The field of ophthalmology lends itself to premium services for patients. Premium services genuinely improve our patients’ lives. And premium services help build the reputation of the practice.

Cutting waste and gaining greater efficiencies

What we’ve done with our practice electronically is critical to our future security as ACOs continue to grow. Not only for the interconnectedness within the office but also because the system puts us in a position to show our value to payers. I can’t stress enough the value of knowing what kind of outcomes we’re getting and being able to share that information in inarguable, transparent formats. It’s powerful and provides value for both the practice and our payers. OP

John A. Hovanesian MD, FACS, is a clinical instructor at the Jules Stein Eye Institute, UCLA, and is in private practice at Harvard Eye Associates in Laguna Hills, Calif.