Surgeons Not Very Involved in ACOs, Survey Says
Written by Editor   
Tuesday, June 10, 2014 10:50 PM

Accountable Care Organizations have given little attention to surgery in the early years of the Medicare program, choosing to focus instead on managing chronic conditions and reducing hospital readmissions.  That's according to a case study and survey. The authors conducted case studies at four ACOs in 2012 and sent a survey to all 59 Medicare ACOs in the first year of the program, with 30 responding. 

"We found that thus far, very little of the strategic attention seemed to be devoted to surgical care and the integration of surgeons into the ACO."  They found that surgery was not part of the strategic plan for the first year at any of case study ACOs, and 86 percent of survey respondents rated the priority of reducing unnecessary surgery as "medium," "low," or "very low."

It's not just surgeons, "Dermatologists, endocrinologists, all the different specialties want to know how they fit in, but generally ACOs are not prioritizing the specialties. They're focusing on the lowest hanging fruit, and generally the specialties aren't the lowest hanging fruit." It's easier to focus first on things like reducing expensive hospital admissions by managing the care of patients with chronic illnesses, including diabetes.

Another reason is that it's hard for an ACO to figure out how to share savings with specialists like surgeons. With a primary care physician, it's relatively easy to figure out their share of the ACO's savings by factoring in the number of patients they see. "It's harder with specialists who may only see a handful of patients a week." 

Reducing unnecessary surgeries might be better achieved by helping primary care physicians change their referral patterns rather than targeting the surgeons themselves. Many patients may not need to be referred to a surgeon at all when there's a treatment. And for those that do "you want to refer to a surgeon who is thoughtful and conservative about the decision to operate."