The most efficient means of using ACOs is to employ physicians by a hospital. Kaiser get’s around this because Southern California Permanente is a foundation which employs the doctors and Kaiser Hospital contracts with that medical group. That is because hospitals were previously forbidden to hire physicians. Time and trends have altered that formula, however legally hospitals are banned from controlling physicians due to a conflict of interest. I believe it should still be the same, and it may be that in certain regions ACOs may fall under anti-trust regulation.
Many physicians have ‘rolled over’ and succumbed to threat of insolvency, brutal administrative loads, the threat of malpractice, long hours and irregular call schedule.
Social media is playing a larger role with open communications which are transparent and reveal how dissatisfied physicians have become with the system, the dysfunctional way the accountable care act is attempting to correct increased costs, and improve outcomes. The addition of electronic records, while having some merits has added to expense, decreased efficiency, and has converted a highly skilled physician who usually generates at least $ 200.00/ hour in gross revenue (before overhead and tax burden) into a clerk (hire for 12.00/hour), The wise thing to do is pay a clerk $96.00 dollars/day + adjunctive costs such as health insurance, overhead for workman’s compensation, liability, vacation time, etc. It is often said that an employees salary is double by ancillary cost. Using that formula that clerk would cost about $180.00 per diem. However each time you hire an additional employee it adds to the complexity of the human equation, absenteeism and more.
Add to all the above the mandate for outcomes, reduced readmissions, and demand for analytic data pushes the balance toward ACOs
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