What You Need to Know about ACOs

The current ACO debate is highlighting another characteristic of rheumatologists: They’re not homogenous. Some take a greater interest in inflammatory diseases, while others are more focused on musculoskeletal disorders. Dr. Hochman suggests that general rheumatologists may need to think about the need to hone their abilities in both areas of practice, demonstrating agility and value in the ACO environment. He notes that this may be less of a factor for academic rheumatologists, who are more concerned with grants than reimbursement systems because of the nature of their work.

“At the end of the day, rheumatologists will likely care for the patients they’re trained to care for,” says Dr. Dwyer. He adds that ACOs may force a distinction between rheumatologists who care only for more complex patients and those who provide a considerable amount of primary care. “The distinction will be more noticeable, and some of those rheumatologists on the border may find themselves moving into more of a primary-care role,” he adds.

If any group of rheumatologists is a likely loser here, it is solo practitioners or small, single-specialty practices, says Dr. Hochman, who adds that small group practices are becoming extinct regardless of specialty. In Washington state, for example, only about 15% of physicians work in solo or small group, single-specialty groups. “It’s not sustainable, and I think in five years they will no longer exist,” he says.

Mary Desmond Pinkowish is a medical journalist based in New York.

References

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