ACOs, a coin termed in 2006 and formally introduced into the healthcare industry through the Patient Protection and Affordable Care Act, aim to reduce healthcare costs by making providers responsible for providing high-value care — good outcomes at a lower cost.
While relatively sparse now, the ACO care model will continue to expand across the entire industry, said Dr. Shamie. “As much as we may not like it the train is rapidly moving forward,” he said.
The profits and performance bonuses available to successful ACOs have attracted larger healthcare organizations, and many large delivery systems now have ACOs that extend into surrounding communities, said Dr. Shamie. “That’s how our economy works — when there’s money in a field, big companies come in and take over,” he said.
This has placed smaller and solo physician practices in a quandary, as there are both benefits and drawbacks to accepting a job offer from these physician-hungry ACOs.
One of the main benefits is job security. “In this changing market, where the money’s going to ACOs, they’re controlling the market and if you’re employed, it offers security,” said Dr. Shamie.
However, this job security comes at a price, often reductions in salary. The salaries of spine surgeons employed by ACOs are at the whim of administrators who may not fully understand the expense of spine surgery or the cost savings generated by a spine surgeon individually, which can lead to reductions in salary, he said.
To make the decision about ACO employment, “be honest with yourself,” said Dr. Shamie. “Ask, ‘Am I a risk-taker or at the phase in my career where I can take risks, or should I be more risk-adverse in the current environment?”
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