7 Options for Physicians Wary of Employment

Kenneth J. Terry, MA

Disclosures

January 13, 2016

In This Article

ACOs: Are They Right for You?

To date, ACOs have been more hype than substance, Gosfield argues. "They exist" in areas where she has clients, "but most of them don't have contracts."

Bundled payments are more likely than ACOs to succeed, she says, because they apply to a particular patient's condition rather than an entire population. Through the use of actionable data, she notes, physicians can intervene to improve care. In contrast, ACO contracts don't provide a specific focus for improvement.

LaPenna doesn't write off ACOs so quickly. "The projections of capitation and bundled pricing programs are imbedded within the Affordable Care Act," he observes. "CMS is already moving in that direction, and once ACOs are established and ingrained with the medical reimbursement fabric, they won't go away easily."

Zetter doesn't dismiss ACOs either, but he advises physicians to look at each one carefully. "ACOs have a lot of variations, and you have to ask serious questions before you join one," he says. "Why do you want to join, how will it benefit the practice, who will make decisions on how benefits are derived, and what's the risk?"

Kennedy is skeptical of ACOs. They must be of a certain size to qualify for the Medicare Shared Savings Program, he points out, and they're also responsible for the entire cost of patient care. "That's hard to do unless you're part of an integrated healthcare system or a large group that has hundreds of doctors."

Overall, he concludes, "The outlook is still fairly good for independent practices of a certain scale." The healthcare system increasingly emphasizes ambulatory care, he points out, and the physician-patient relationship will be increasingly important in healthcare reform. So office-based physicians will always be needed, whether or not they're employed.

"That being said, smaller independent practices are going to struggle," he says. "There are going to be some very successful physician organizations. But they have to achieve a pretty large scale to be meaningful in those markets and to provide the sorts of services those organizations are going to need to be successful."

Conclusion: Whichever option you think is right for you, make sure you examine the pros and cons thoroughly. Talk to physicians who are already in that situation, and take your time to decide which is most likely to bring you financial and emotional rewards.

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