Physician alignment is biggest obstacle to ACOs

As healthcare organizations and providers consider making the leap to an accountable care organization (ACO), a new survey finds that the biggest obstacle to forming one is physician alignment, according to healthcare staffing agency AMN Healthcare.

AMN asked 882 healthcare facility administrators and physicians about forming ACOs. Fifty-eight percent were in the process of doing so or considering it, but 42 percent did not see ACO formation in the foreseeable future.

Of those who were in or considering ACOs, 42 percent said physician alignment was the primary reason for not moving toward ACOs, as well as lack of capital (38 percent), lack of IT (31 percent), and lack of evidence-based treatment protocol (25 percent).

"While capital and data are essential to forming ACOs, the success of this emerging model turns on people," said AMN Healthcare president and CEO Susan Salka in a statement.  "Health facility leaders and physicians must align their interests, communicate and cooperate for this model to work," she said.

Of those respondents who are not considering ACOs, 40 percent similarly said physician alignment was a reason not to, followed by lack of capital (31 percent), lack of IT (26 percent), and lack of evident-based treatment protocol (23 percent).


Respondents considering ACOs (58%)

Respondents not considering ACOs (42%)

Physician alignment



Lack of capital



Lack of IT



Lack of evidence-based treatment protocol



"Aligning the interests of physicians and hospitals has historically been difficult, as the two sides have often conflicted over patient care, cost, reimbursement and governance issues," states the survey. "These issues continue to resonate in the ACO model, as it is unclear who will be at the helm of these organizations, how risk will be shared, and how reimbursement will be calculated. In addition, in an era of physician shortages, it is uncertain whether or not hospitals and other facilities will be able to staff the primary care and other physicians required by federal regulations to form ACOs."

The majority of administrators and physicians still hope that ACOs will provide cost savings and improve quality over time, according to the survey.

For more:
- read the full AMN report (reg. req.)
- read the AMN press release

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