Spine Surgeons: Is An ACO in Your Future?


Five spine surgeons responded to this week's question: do you see yourself or your group participating in an ACO-like arrangement now or in the future? Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question is: If cost wasn't an obstacle, would you ever consider using robotic guidance during a procedure?

Please send responses to Laura Miller at laura@beckershealthcare.com by Tuesday, Jan. 24 at 5pm CST. Limit responses to five sentences or less.

Dennis Crandall, MD (Medical Director, Sonoran Spine Center, Mesa, Ariz.): Several local hospitals are trying to rally their medical staffs to join in on an ACO. Biggest problem: physicians already feel taken advantage of by their hospitals, and doctors I talk to are certain that a hospital-centered ACO will continue if not worsen that trend. We are shareholders in a physician-owned orthopedic and spine hospital which will be ideal for an ACO. We are incentivized to look out for patient quality, maintain control of costs and critically review new technology.  

Ara Deukmedjian, MD (Founder, Deuk Spine Institute, Melbourne, Fla.): Yes. I feel ACOs have the potential to reduce cost by improving efficiency in delivery of quality healthcare. However I am also concerned because there are currently several large health delivery systems that are government controlled and are shining examples of inefficiency — such as the VA system and Medicare. How can the government lead us (private sector delivery models) to efficiency nirvana when they can't fix what they directly control? I am concerned that ACOs are just a guise designed to further reduce insurance company payments to providers in an effort to further reduce their financial risk and dramatically bolster their own profit margins. Essentially, insurers will do what they do best by shifting more healthcare dollars away from patient care and back into their own abysmally deep pockets.

J. Brian Gill, MD (Spine Surgeon, Nebraska Spine Center, Omaha):
If ACOs survive, then probably so to remain competitive and relevant in the marketplace. Being an independent physician, I am unsure how competing ACOs in a community would pay for the services that I rendered. For example, would a one ACO reimburse at a higher rate versus the other to potentially gain the business.

Paul Slosar, MD (President, SpineCare Medical Group, San Francisco Spine Institute):
As far as I can determine this is capitation déjà vu, which failed miserably in California many years ago. Insurance companies have decades of experience in risk assessment and employ armies of actuaries. Hospitals and doctors have zero experience in this space and will likely get skinned alive.  

Brian Subach, MD (Director of Research and Spine Surgeon, Virginia Spine Institute, Reston): Probably not.

Related Articles on Spine Surgery:
Where are Spine Surgeons Focusing Research & Development in 2012?

What is Your Number One Concern for Spine Surgery in 2012?

What Was the Most Important Development in Spine Surgery for 2011?

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