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ACO, PCMH Models May Not Be Boosting Care Quality, Satisfaction

By Jennifer Bresnick

- Providers who are participating in accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) are not sure that these novel care delivery models are having a positive impact on patient care quality or provider satisfaction, according to a new survey from The Commonwealth Fund and the Henry J. Kaiser Family Foundation. 

PCMH and ACO care quality

While half of physicians and nearly three-quarters of nurse practitioners believe that the underlying EHR and health IT infrastructure that supports these delivery models is a benefit for patients, only one-third of physicians and 40 percent of NPs and physician assistants believe that PCMH structure is having a measurable positive effect on the quality of care. 

Even fewer think that accountable care organizations are worthwhile investments, with a quarter of physicians stating that ACO participation has been a decidedly negative development.

Researchers polled 1624 primary care physicians and 525 mid-level providers, such as NPs and PAs, many of whom have first-hand experience with emerging care delivery models.  Approximately thirty percent of the physicians in the survey said that they are part of an ACO or that their practices are certified as a PCMH or advanced primary care practice. 

Despite the fact that providers are generally satisfied with the increased use of EHRs and health IT tools that facilitate population health management and patient engagement, they are not so certain that these technologies are being put to their best use, especially when it comes to quality reporting and associated financial penalties.

Fifty-percent of physicians and 38 percent of mid-level providers believe that clinical quality metrics used to assess performance are having a negative impact on patient care.  Quality reporting was unpopular among providers participating in all types of payment structures, from fee-for-service to value-based reimbursement.

“Among physicians working in ACOs, views were divided between positive and negative,” the survey says. “Providers were more negative about the use of quality metrics to assess their performance, even those providers who receive incentive payments based on quality.” 

Fifty percent of physicians across the reimbursement spectrum stated that quality metrics have a negative impact on the ability to provide quality care to patients, although providers participating in quality-based incentive programs were almost ten percent more likely to say that measurement frameworks are a good idea than those who do not receive bonuses for achieving top marks for quality.

The survey suggests that providers may simply need more time – and more evidence – to get comfortable with the notion that the PCMH and ACO models may help to reduce costs, raise revenues, and improve patient care.  However, “dissatisfaction with new models may not be solely attributable to a difficult transformation process,” the study points out.  “Larger culture change within the practice of medicine may be a necessary first step before delivery system reforms such as ACOs and medical homes are fully accepted on the ground.”

A large number of providers are not planning to stick around to find out if their organizations can navigate the fundamental changes required for success with these new models.  The poll found that nearly half of physicians and more than a quarter of NPs and PAs are considering an early retirement due to recent trends in the healthcare industry. 

Physicians in particular took a dim view of their changing roles in team-based care frameworks, with 41 percent stating that increased reliance on nurse practitioners and physician assistants may be detrimental to patient care quality.  In contrast, and perhaps unsurprisingly, 88 percent of NPs and PAs eagerly approved of a shift towards a team-based care framework that highlights their contributions.

“As primary care transformation efforts mature and spread, it will remain important to judge their effects on patients in terms of access, quality, and costs of care,” the study concludes. “However, it is also important to assess their effect on primary care clinicians. Market trends in health care have been affecting physicians’ satisfaction for more than 20 years. It will be important to monitor providers’ satisfaction with delivery reform efforts.”

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