Value-based care is one of the biggest paradigm shifts facing orthopedic surgeons. It can affect not only the quality of care, but also how surgeons get paid. Going from a fee-for-service model to pay based on performance is a big change for orthopedic surgeons. While such a big shift in payment might, understandably, make surgeons nervous, there are a lot of potential benefits for both patients and surgeons.
We interviewed Debra Stevens, Executive Director of Marketing and Communications for Arizona Care Network, on the podcast. Arizona Care Network is an accountable care organization (ACO) that has had great success with implementing value-based care in their community. Debra shared a lot of great information on how Arizona Care Network set up their ACO, and how both surgeons and patients have benefited since.
How Can Surgeons Benefit from ACOs?
ACOs were developed, in part, to help address the rising costs of healthcare. By tying provider reimbursement to patient outcomes, the goal is to curb the rate of increase for healthcare costs. At the same time, ACOs are highly focused on patient care, which reduces the overall cost of care over time.
Though Arizona Care Network is just one example of how an ACO might run efficiently, there are a lot of things to learn from their approach.
Arizona Care Network does work to support patient outcomes, so the success of the treatment is not entirely dependent on the provider. You might have highly-skilled providers, but sometimes there are circumstances outside of the providers’ control that can affect outcomes.
Sometimes patients have trouble with medication adherence, or getting transportation to their appointments. Patients may see a provider outside of the ACO network, which makes tracking their health data more difficult. All of these things can factor into the patient’s ultimate outcome.
Arizona Care Network addresses these issues in a few different ways:
- They have providers in all different specialties, so that patients can be referred in-network if they need specialty care.
- By referring in-network, the organization can track the patient’s data from provider to provider, so that everyone involved in a patient’s care has the patient’s full medical history.
- Tracking data in this manner also helps the organization track trends, so that they can identify potential high-risk patients and provide additional support to ensure those patients don’t slip through the cracks.
Arizona Care Network also incentivizes providers to hit certain goals in the form of additional pay. The goals help the ACO further its cause of helping the community get healthier, and the doctors also benefit.
How to Get Surgeons on Board with an ACO
It can, understandably, be quite a shift to get an entire practice or health system on board with joining an ACO. It’s a big shift from the way a practice normally operates, and from the way surgeons normally get paid. So, it’s not likely that everyone will get on board, no questions asked.
The big thing here is to focus on the benefits of the ACO model. Yes, payments are different. However, certain goals can be incentivized, allowing surgeons to make extra money. This is less likely to happen in a fee-for-service model.
The Power of Data Collection
There is also the power of data collection, and how that can allow surgeons to provide better and more efficient care for their patients. They’ll have access to all of the information previously collected on each patient from other in-network providers, which allows surgeons to make appropriate care suggestions for patients without having to take yet another rundown of the patient’s history. This also allows surgeons to better recognize potential risks and complications before the procedure and address them ahead of time, which helps improve outcomes and patient satisfaction, so that these patients continue to return.
Steady Referral Sources
Another big reason for surgeons to join an ACO is the potential for referrals. Hospitals and health systems are merging and acquiring smaller practices. Because of this, surgeons who stay in private practice may lose their key referral sources and have to find other means of getting new patients. With an ACO, doctors in other specialties refer within the ACO network so that they can continue to track data on that patient and ensure they get the care they need. For an orthopedic surgeon whose referral sources are drying up, this is a great way to secure a healthy flow of new patients.
The Win-Win for Surgeons & Patients
Ultimately, orthopedic surgeons want healthy, happy patients. Though an ACO is different from the usual approach, it is one way surgeons can keep up with the rapidly-changing healthcare landscape. Surgeons get the data and support they need to take excellent care of patients, and have a steady source of referrals. Patients get high-quality, comprehensive care. When done right, it’s a win for everyone.