ACOs not just for large practices

While large organizations, such as WESTMED Medical Group in New York have reported the most success in forming accountable care organizations, a handful of small family practices in Nebraska are confident that they won't just benefit financially from their ACOs, but will gain more satisfaction in the way they practice as well.

In fact, Gerald Luckey, M.D., the lead physician at the Butler County Clinic in David City, Neb.--one of the nine small, independent groups belonging to the South East Rural Physician Alliance (SERPA)  ACO--told AAFP News Now that as part of the ACO, his practice is moving toward the way he's wanted to practice for 40 years.

"[This is] a system where we're doing things that count as far as quality of care is concerned, not just generating volume," he said. "This is the future of healthcare."

Many of the members of the SERPA ACO, which formed in January to participate in the Medicare Shared Savings Program, have worked together since the 1990s under an independent practice association formed to protect their interests in the era of managed care.

Today, being a physician-led organization gives members advantages over more typical vertically arranged ACOs, according to Robert Wergin, M.D., a member of the SERPA-IPA board of directors and the American Academy of Family Physician's current president-elect.

In hospital- or health system-sponsored ACOs, he explained, there's pressure to make referrals to specialists within its system. "But who can do the highest-quality, cost-effective aortic valve for your mom? It might be someone outside of that health system," Wergin said. SERPA-ACO's horizontal structure enables its physicians to pick a specialist based on quality numbers and without considering system affiliation.

Nonetheless, SERPA-ACO members face challenges as well. One of the biggest challenges is compiling data for the 33 quality measures Medicare requires. Although data for 11 of the measures come from claims data compiled by Medicare, they must pull data for the other measures from six different EHR types in the ACO practices.

"Fortunately, we found a vendor who can interface with four of the six EHR types," said Joleen Huneke, the ACO's executive director. "The other two practices will have to extract data by hand until their EHRs have interface capabilities. The vendor will aggregate the data our practices provide and the claims data from CMS, and then we will submit the resulting file to CMS."

To learn more:
- read the AAFP News Now story