Physicians Hopeful over future of ACOS

When it comes to the possibility of replacing the sustainable growth-rate formula used to determine physician Medicare payment, 2012 might not look a lot different from the past year.

Donald Fisher, president and CEO of the American Medical Group Association, is as pessimistic as ever—but he expressed some optimism that a “carve-out” or “separate bucket” could be created for Medicare payments for accountable care organizations.

“We’re probably going to see the can be kicked down the street again this year,” he says of the SGR. “I don’t see any chance of replacing or repealing it.” But, if ACOS live up to their potential for providing higher-quality, lowercost care, “there should be some recognition,” Fisher says. The AMGA has been a champion of the ACO concept, and Fisher says the final CMS rules on ACOS for Medicare were a vast improvement over what was first proposed. So he sees momentum building. “I think they took 90% of what we asked for,” Fisher says. “Now I see some excitement.”

For 2012, Fisher says he sees further consolidation or hospital acquisition of physician practices driven in part by the need or desire to pool resources on health information technology purchases and administrative overhead. This consolidation also will help create opportunities for better care coordination and eliminate variations in care that offer no value to patients. The trick, Fisher says, is to eliminate most variation without stifling innovation.

Fisher says practices will also be challenged by the switch to the new ICD-10 diagnostic