Experts: Practices should "walk before they run" into IPAs and PHOs

Small physician practices can maintain their independence while benefitting from strength in numbers by joining independent practice associations (IPAs) or physician-hospital organizations (PHOs), particularly when it comes to helping patients manage chronic disease, according to a study published in Health Affairs.

In particular, the study of 1,164 practices with fewer than 20 physicians found that practices that were part of IPAs or PHOs used more than twice as many care-management processes (e.g, electronic patient registries, nurse care managers, etc.) as other practices.

Further, the care-management processes found in the IPAs and PHOs, according to authors Lawrence Casalino, M.D., Ph.D., and colleagues, demonstrate the clinical integration that qualifies these organizations in the eyes of the Federal Trade Commission and Department of Justice to collectively bargain with insurers.

It's important to note, however, that the authors collected their data before the launch of the Medicare Shared Savings Program in 2011. The caveat, therefore, is that practices should "walk before they run" into emerging alignment models, experts told Medscape Today.

This point comes in light of the recent news that nine of the 32 organizations participating in CMS' Pioneer ACO program, including several IPAs, announced they were exiting the program. According to Medscape, seven of the organizations switched to the lower-reward yet risk-free ACO model in the Medicare Shared Savings Program after failing to save money for Medicare, while the other two dropped out of the program completely.

Therefore, IPAs aiming to become ACOs should begin with the Medicare Shared Savings Program before aiming for the Pioneer level and its risk, Albert Holloway, the president and chief executive officer of the IPA Association of America, told Medscape.

Furthermore, he cautioned that simply joining forces on paper does not translate to IPA success. "IPAs are positioned to help independent physicians play a role in these [healthcare reform] structures," said Holloway. "But physicians need to roll their sleeves up and get involved in the IPA and support what the IPA is trying to do to meet [government] requirements."

To learn more:
- see the article from Medscape Today
- see the abstract from Health Affairs

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