AMA warns of '90s time warp: ACOs need solid structure

Accountable care organizations (ACOs) are not a one-size-fits-all solution to hospital-physician integration, suggests a new manual from the American Medical Association (AMA) on hospital-physician employment.

"Not only in its membership but also in its structure, an ACO is not a one-size-fits-all proposition but must account for the community dynamic, resources, and needs," states the report, "ACOs, CO-OPs and Other Options: A 'How-To' Manual for Physicians Navigating a Post-Health Reform World." ACOs are required to form a legal structure to participate, but that structure may vary from one ACO to another.

The manual states, "...[T]he ideal legal structure depends on many factors, including the ACO's goals, the quantity and quality of available participants, cultural differences of participants, and financial resources."

ACO skeptics have speculated the next wave of healthcare integration will repeat the so-called failed experiment of hospital purchases of physician practices and consolidations in the '90s.

"The current situation presents enormous opportunity and enormous risk," said Catherine I. Hanson in the manual, likening the current proposed healthcare reform and integration options to the early 1990s. "While some of the systems that were created during that period have continued to flourish, many others failed." She continued, "But physicians do not have to repeat the mistakes of the past--they can learn from them."

The manual suggests six of the following core ACO strategies:

  • Shared vision that identifies long-term goals about community health, provider capabilities, and state and federal health policy
  • Structure with strong leaders, transparent decision-making, clarity on participants' roles
  • Financial alignment
  • Clinical and organizational infrastructure, including coordination of care, finances, and information
  • Sufficient capital
  • Trust and communication between participants

To learn more:
- read the AMA press release
- read the full report (.pdf)
- check out the chapter on physician-hospital employment agreements

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