Accountable care organizations' impact on dermatology largely uncertain

Key Points

National report - When it comes to newer healthcare delivery models, experts say accountable care organizations (ACOs) may impact dermatology only in highly competitive markets. Still, dermatologists worry that ACOs could set primary care physicians (PCPs) and specialists at odds, and that specialists' roles in shared-savings programs remain highly uncertain in today's healthcare arena.

Brett Coldiron, M.D., says the ACA amounts to "government sponsorship of large multispecialty clinics, some with capitation." Capitation pits primary care physicians (PCPs), who have assumed financial risks for managing a large population, against specialists, he says, because specialist referrals cost extra. Ultimately, Dr. Coldiron says, specialists leave these arrangements. He is an American Academy of Dermatology board member, but his views are personal and do not represent the AAD.

ACO specifics

Additionally, final Medicare Shared Savings Program rules that took effect Jan. 2 created experimental alternatives, including the Pioneer ACO, which allows participants to earn higher levels of shared savings - and suffer bigger losses - than are available in the original ACO model, says CMS's Center for Innovation. CMS announced its first 32 Pioneer ACOs on May 22.

Conversely, the Advance Payment ACO aims to help smaller ACOs with less access to capital participate in shared savings by paying participants in advance and recouping these advances from an ACO's savings over time. The first five Advance Payment ACOs entered into such agreements with CMS beginning April 1.