Financial concerns, quality issues and the interoperability of electronic health records (EHRs) are among the reasons nearly half of the hospital executives recently surveyed by Purdue Healthcare Advisors have no plans to implement an accountable care organization (ACO) in the near future.
Conducted in October 2013 among 206 hospital executives at a director level and above, the survey also reveals that executives are struggling with finding solutions for lower reimbursements and increased costs, while still maintaining an acceptable level of quality care.
Executives are waiting for ACO models that are more stable and mature to avoid having to reinvest funds to implement changes or updates, according to the survey. The executives who do not have plans to implement an ACO model in the future cited these reasons:
- More than half (52 percent) feel there are too many unknowns and want to see stronger evidence and a consistency of successful models;
- Almost half (49 percent) feel their hospital is too small for an ACO-like model;
- One fourth (26 percent) say that the financial investment outweighs the potential incentives or bonuses at this time;
- Just 13 percent feel the performance benchmarks are not realistic for their hospital; and
- Four percent are concerned that the transition would overwhelm staff.
Survey respondents also cited diminishing patient volume, decreased reimbursement rates and other Affordable Care Act (ACA)-related unknowns as financial concerns and cited the following strategies they are implementing to reduce costs:
- More than half (60 percent) are focused on reducing waste and inefficiencies;
- Nineteen percent are considering staff and salary reductions;
- Fifteen percent are working to improve quality of care, and
- EHRs drive a higher need for support.
While nearly all (95 percent) respondents surveyed are implementing EHRs, with 49 percent in the process of completing or having completed Stage 2 Meaningful Use; 41 percent in the process of completing or have completed Stage 1 Meaningful Use, and five percent migrating to a new EHR, they voiced concern about the technology, including:
- Interoperability with other providers (56 percent);
- Data retrieval and analytics (50 percent)
- Ongoing staff readiness and training (49 percent)
- Infrastructure and technology (49 percent);
- Patient engagement (37 percent);
- Vulnerability to data/security breaches (35 percent);
- Vendor partnership and engagement (31 percent)
- Disaster recovery planning (30 percent); and
- Long-term preservation of the records (18 percent).
Among the biggest challenges facing hospital executives as they implement EHRs are physician buy-in (68 percent), employee readiness (39 percent), vendor engagement and partnership and patient engagement (21 percent.)
Source: Purdue Healthcare Advisors , December 12, 2013
Guide to Accountable Care Organizations lays the groundwork for an ACO program, delivering a comprehensive set of 2012 ACO benchmarks from 200 companies; a framework for clinical integration, a key ACO prerequisite that puts participating providers on the same performance and payment page; and guidelines for physician-led ACOs.