Physicians and ACOs: Skepticism Abounds

Last in a series of five articles on the 2011 MMS Physician Workforce Study

With global payment contracts and accountable care organizations becoming more prevalent in Massachusetts, we thought it would be important to ask physicians what they thought of these new practice arrangements.

About 57 percent of physicians said they were familiar with global payment contracts and 58 percent said they were familiar with ACOs. Forty two percent said they were willing to enter into a global payment contract, and 49 percent said they would join an ACO. Physicians who were familiar with the terms were only slightly more willing to participate than those were not familiar.

There is a strong divide between specialists and primary care physicians. Almost 72 percent primary care physicians said they were likely to join an ACO, compared to 50 percent of specialists. This correlates strongly to specialists’ long-stated worries that their referral patterns – the lifeblood of their practices – would be disrupted or diminished by ACOs.

The survey didn’t ask for the reasons behind their answers, but preliminary results from research that the Harvard School of Public Health is conducting for us may shed a light on that.

In that study, only 7 percent of all respondents said their practice has access to computer systems to manage clinical information, and only 29 percent said their group is ready to enter into a global payment contract. These are important preconditions to succeeding in a global payment environment.

Will implement global payment system achieve what its sponsors hope? Physicians are skeptical.

Fewer than half (44%) believe that medical spending will decrease. Even fewer, 19 percent, believe that quality will improve. Most believe that that global payments will reduce physician incentives to work (59%) and reduce the numbers of physicians willing to work in Massachusetts (76%).

Sponsors of a global payment system need two groups to believe it will work – physicians and patients. We don’t have data yet on patients, but the evidence suggests that physicians aren’t there yet.

Read the workforce study at

End of series. Read the other posts in this series here.

  1. Milton Hirshberg, MD, delegate says:

    Doctors are in a quandary when faced with a response to questions about global payment, for GP has a useful place in a rationally designed system of care of one model or another. But finding a useful niche for GP in the system in the US, so badly formed by accidental accretions and random external tampering, has poor odds to make much difference. No wonder that only 19% of doctors believe quality will improve. It behooves us at this depressing point in efforts to achieve MMS objectives of cost stabilization and excellence in medical care to no longer keep our eyes shut to the evidence that we as a professional society are on the wrong path–that the system of care we support is genetically incapable of offering success. It does make some doctors affluent; it does offer enormous profits to the drug and insurance industries; it draws campaign donations to politicians opposing reform; but the patients and the economy suffer and much of our society’s needs go unmet, while we spend the greatest amount of wealth and resources on wellness than any other society on earth. Inanity. Unwisdom. Folly. and Immoral and Cruel also.

    Medicine, we know, is a profession that operates under a condition of trust. Trust can be compromised when the opportunity for profit pervades this system. Despite this hazard, America has been trying to sustain a market model of health care delivery which is completely antithetical to the assumptions underlying our profession. Doctors, like the clergy, like lawyers, are in a field where the assumptions of the market don’t fit at all. Let us have authentic reform. Reform need not interfere with a doctor’s need to support her/his family.

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