Under the Affordable Care Act set to go into full effect in early 2014, one of the most controversial measures, at least for providers, is the new provision for accountable care organizations.
In the most straightforward terms, ACOs are networks of health care providers who work together to provide coordinated care for a particular group of patients. Because their primary focus is containing the costs of health care while simultaneously improving quality, ACOs are reimbursed by Medicare according to patient outcomes. In other words, the more effectively and efficiently a provider in an ACO treats a patient, the more they will be paid by Medicare.
Because much of the attention ACOs have received has been focused on cost cutting, some in the radiology field believe the organizations have the potential to seriously impact their work, by reducing utilization rates and lowering reimbursements. Some assume that because doctors will be more focused on reducing health care costs than before the law was passed, they may be reluctant to order certain imaging tests, even if those tests have previously proven valuable.
However, others argue the development of ACOs actually presents some significant opportunities for radiologists and the radiology field. They point out the main focus of the discussion regarding ACOs thus far has not been related to decreasing imaging utilization rates, but more geared toward reducing patient length of stay, readmissions and the need for skilled nursing care. While reducing waste in the sense of limiting the number of repeat or unnecessary imaging procedures is obviously a concern, decreasing overall utilization of imaging is not the goal of ACOs under the Affordable Care Act. In fact, the new arrangements could be a good thing for the field.
A New Voice in Health Care
Given that ACOs are focused on improving quality of health care, radiology has a lot to bring the table. Several key areas where they can provide valuable input include:
Diagnostic expertise. Traditionally, radiologists have not been well incorporated into the diagnostic/treatment workflow. Physicians determine what tests to order, and the radiologist interprets the results. However, under the new model, radiologists have the opportunity to play a greater role in the care team, and offer their considerable expertise and professional experience to the discussion. With an eye toward better care, a radiologist could recommend a more effective imaging procedure —which may or may not be more expensive — that would lead to a better outcome for the patient.
New safety and quality roles. Radiologists offer unique knowledge and skills related to workplace and patient safety. In some health care environments, they already provide education and services related to such topics as radiation safety or maintaining accreditation. Under the ACO model, these services can be expanded, with radiology playing a greater role in ensuring all staff is safe and compliant, and eliminating the possibility of costly errors or violations.
Greater input into IT decisions. The Affordable Care Act places a great deal of value on technology and the role it will play in quality care. Rather than allowing IT staff to make decisions in a vacuum and develop solutions that may not work for all cases, radiology staff can bring their considerable technical expertise to the table, providing ideas and guidance to develop IT solutions that will help ensure forward movement toward the goal of quality care.
Developing new efficiencies. Because one of the stated goals of ACOs is to create operational efficiencies to reduce waste, radiology is in a unique position to create streamlined and efficient workflows that can serve as a model for other areas. In some places, this is already happening, through systems such as teleradiology which allows imaging departments to use the services of radiology professionals to read images from a distance. Such an arrangement allows facilities to maximize staffing levels while also providing excellent service; it also allows for additional operational efficiencies like expedited second opinions.
As pieces of the Affordable Care Act are rolled out and changes begin to take place, there is a lot of uncertainty and apprehension about how various groups will be affected by the new rules. While ACOs will certainly impact the way most providers approach the way they treat patients, radiologists are uniquely positioned to play an important role in the overall delivery of care and should view the new networks as a source of opportunities.
Image by Ambro from freedigitalphotos.net
About the Author: Darrin Dodge works for ONRAD, Inc.