ACOs Are Coming to an End

A report by the National Association of ACOs (NAACOS) shows that ACOs (Accountable Care Organizations) participating in the Medicare Shared Savings Program are making preparations to abandon Obamacare’s ACO initiative. The report shows that 66% are not intending to stay in the program and another 26% are currently undecided. That leaves a mere 8% of ACOs which are planning to sign a second contract with the government. The president of NAACOS stated that if CMS doesn’t address issues, the program “will no longer exist and the high hopes of DC policy-makers to migrate ACOs to capitation and two-sided risk will be impossible.”

NAACOS also reported that the costs to run the ACOs are insurmountable. Respondents reported an annual mean of $1.5 million management costs directly attributable to ACO operations.

There are also issues with the metrics CMS uses. The report shows that no ACO would have had a perfect quality score, and every ACO that achieved shared savings with CMS would have had those savings reduced by the quality scores. The president of NAACOS summed it up well when he stated, “The huge investment by ACOs in improved care goes largely unrewarded.” This is yet another example of how healthcare reform has fallen short of intended goals. NAACOS President Clif Gaus said, “While CMS has made modest improvement to the ACO Quality Benchmarking, it is still a punitive program that will only lead to future reductions in savings paid to the ACOs who have worked hard to achieve those savings. Coupled with the many attribution and financial benchmarking defects, the Medicare Shared Savings Program is not sustainable in its current configuration and will decelerate the pathway to accountable care for Medicare Beneficiaries.”


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Ethics Assessment for Practice Managers

A practice manager must act with integrity at all times. The outward example the manager sets is constantly observed by her subordinates. She is the model of behavior by which the staff she leads is most influenced, and therefore her conduct must be of the highest quality.

Ethical conduct is facilitated by good organization and the two generally work hand in hand. When disorganization is evident, ethical behavior is also affected. Individuals often begin to take shortcuts to get things done, perceiving themselves as part of a hollow, disorganized practice with a thin framework.

When managers first join a practice, they should study the quality of the ethical climate, making changes as appropriate to improve ethical actions. Managers are not only required to act properly in accordance with various laws, they are expected to know them well so that they can recognize unethical behavior in others.

Usually leadership cannot succeed without well-executed management, and successful practice managers must be competent in both their managerial and their other leadership skills. If high standards are found to be rare or non-existent among team members, then practice managers must ensure that standards of proper conduct or behavior are established and honed. Healthcare practice management is a profession and as such it must establish minimum standards of behavior.


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Physicians’ Financial Affairs

Medicine is not a good way to get rich. Most doctors incur substantial debts for their education and need many years to repay them. And for those in private practice, they incur the costs of starting and running a heavily government regulated business while constantly looking behind themselves over fear of malpractice claims.

AMA Insurance produced a national survey regarding the state of financial affairs of physicians. This survey (conducted by Qualtrics) was sent to 125,000 practicing physicians, targeting all age groups and specialties. The resultant data consisted of a sample size of 2,073. Here are some highlights of the survey’s findings:

50% of employed physicians believe their profession has unique or more complicated financial needs than other professions

72% are concerned about having enough money to retire

65% are concerned about being able to fund long-term care expenses

Top reasons physicians believe their financial lives are different:

84% believe it is because they began their careers later than other professions

56% believe it is because they have concerns over malpractice and other liability risks

53% believe it is because medical school debt repayment delays savings

The survey can be found here.


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Medicare Quality Reporting Programs are Unsatisfactory

Some recent quality reporting programs include the Physician Quality Reporting System (PQRS), the meaningful-use EHR Incentive Program and the Value-Based Payment Modifier Program. These initiatives are part of the U.S. healthcare reform and are an attempt to steer physician behavior to align with the outcomes desired by the government.

The Medical Group Management Association (MGMA) just released the results of a survey on such programs. The survey (Physician Practice Assessment: Medicare Quality Reporting Programs) garnered responses from 1,000 medical groups which include some 48,000 physicians. The report showed that physicians are very critical of the Medicare’s physician quality reporting programs and their impact on patients and practices. Here are some highlights of the survey’s findings:

  • 83% do not believe these quality reporting programs enhance a physician’s ability to provide high quality care to their patients; perhaps we should include physicians in the discussions on patient care.
  • 70% stated the reporting requirements are “very” or “extremely” complex; this speaks volumes about bureaucracy when physicians are having trouble with quality reporting.
  • 85% stated the quality reporting programs negatively affected practice efficiency, support staff time and clinician morale; perhaps the government will next get into practice management.

This is just added validation as to why physicians have stopped taking Medicare patients and many more are making moves in that direction. Good job Washington. I think we all can clearly see now who is “pushing granny off a cliff” and it surely is not the ones involved in patient care.


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