Where do Pathologists fit into Accountable Care Organizations? – Part 5

| January 28, 2011

In the fourth installment of my series entitled “Where do pathologists fit into Accountable Care Organizations (ACOs)?, I mentioned that I personally had not come across much information on oncology and ACOs.  In this post, I highlight some information about the potential plans of a large, single-specialty integrated oncology practice. Ben Calhoun MD PhD. 

As a surgical pathologist specializing in breast pathology, I assume that oncology will be a major area in of intersection between tumor pathology and ACOs (and the rest of oncology care delivery) in my daily practice.  How will ACOs affect those of us who spend most of our time looking at biopsies and resections for cancer?  That question is difficult to answer right now, but another way to approach the question could be to ask: What do we know about ACOs and oncology in general?

The short answer is: not much.  But, I ran across a recent (January, 2011) article by Judy Packer-Tursman on AISHealth.com about US Oncology and it’s potential as a single-specialty Medicare ACO (reprinted from ACO Business News).  Dr. Leonard Kalman, one the Medical Directors for US Oncology (recently purchased by McKesson), discusses an ACO-like arrangement involving US Oncology and the likely initial scope of ACOs in oncology (most likely limited to states or regions, with the possibility of a national approach later).

Dr. Kalman envisions some exclusivity to ACOs designed to deliver cancer care: “When cancer becomes the primary diagnosis, the oncologist basically handles the patient’s primary care, Kalman explains. ‘Remember, the majority of an oncology patient’s care is cancer care,’ he says. So while ACO patients may require occasional care from other sources, including primary care physicians or specialists such as cardiologists or rheumatologists, only oncologists would be affiliated with a Medicare oncology ACO as he envisions it.”  I guess if primary care physicians and specialists are excluded, that takes some of the mystery out of where pathologists would fit in…hospitals aren’t mentioned, either.

Two other points are worth noting:

1.  US Oncology is already involved in an ACO-like venture in Texas that involves Aetna, Inc. and a subsidiary of US Oncology.  “Meanwhile, Kalman says a seven-month-old ACO-type project in Texas — involving Aetna Inc., Texas Oncology (an affiliated US Oncology practice of 300-odd oncologists); and Innovent Oncology, a subsidiary of US Oncology — is expanding and has ‘the potential to go national.’”

2.  US Oncology is in the process of identifying large hospitals and commercial insurance carriers as potential partners for ACOs after the rules are written and released in January 2012. Dr. Kalman tells ACO Business News that “…..a major hospital in Miami has approached his 40-physician practice about handling cancer care in such a way. ‘Our ACO partner is a dominant hospital system where we put basically all of our patients,’ he says, declining to name it.”  Dr. Kalman adds that “the time is ripe for oncology practices to approach commercial managed care organizations and begin ACO discussions, setting the fee schedule and expenditure targets and a shared-savings arrangement. ‘We’ve picked out a commercial insurance plan as a potential partner,’ he notes.”

Another article in the Oncology Business Review (OBR) on Oncbiz.com discusses oncology and ACOs.  In the January 2011 issue of OBR, Allison Shimooka lists 5 key areas for investment in developing oncology ACOs: physician alignment, payer contracting, knowledge management (this means IT), facility strategy (integrating providers and healthcare systems), and patient engagement/activation.  She refers to plans recently announced by US Oncology and Milliman, a Seattle-based actuarial and consulting firm, to “develop a model for physician-led oncology organizations to contract around risk, either through episode rates, bundled payments, or capitation.”  She also mentions that United HealthCare is “piloting a new episode-based payment methodology with 5 private practice medical oncology groups.”

So, it’s clear that regional and perhaps national oncology ACOs are being contemplated by major players.  What, if any, developments should we expect with regional and national pathology groups and ACOs in general and oncology ACOs specifically (assuming such ACOs eventually exist)? 


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Category: Pathology News

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