There continues to be terrific interest in accountable care organizations (ACOs), which are of course a financially risk-based model of providing healthcare to patients who choose to enroll in the Medicare Shared Risk Program. ACO organizations are often led by hospitals and hospital systems, though occasionally by physician organizations. One of the key common threads among these provider led ACOs is the fear of being left out of “the game,” the fear of losing out financially. This fear, however, can lead physicians to run headlong into danger if and when they sign ACO documents.
One of the key ways ACOs get formed involves a stack of contracts being created, then shoved under physicians’ noses. Doctors afraid to lose out tend to just sign. The organizations are really to blame here, when the documents fail to contain material terms to deal with things like: credentialing criteria, disciplinary procedures, financial provisions, how the financial up side or down side can affect physician compensation. The documents are simply slid under their noses and, in fear of being left out, they get signed! Or, as my buddy Rodger says “Ready, shoot, aim.”
Regardless of a doctor’s view of ACOs, no document ought to be signed unless all the questions raised by them are addressed, very clearly and in writing. Be at the table with ACO organizers and do your best to design a good system, but don’t be naïve to think that the unaddressed portions will magically get filled in somehow in a way that benefits you or that even makes sense. At the very least, wait until the document is complete, then consider if you want to sign it.