title: Attention to surgeons and surgical care is largely missing from early medicare accountable care organizations.
abstract: The Affordable Care Act supports the growth of accountable care organizations (ACOs) as a potentially powerful model for health care delivery and payment. The model focuses on primary care. However, surgeons and other specialists have a large role to play in caring for ACOs' patients. No studies have yet investigated the role of surgical care in the ACO model. Using case studies and a survey, we examined the early experience of fifty-nine Medicare-approved ACOs in providing surgical care. We found that ACOs have so far devoted little attention to surgical care. Instead, they have emphasized coordinating care for patients with chronic conditions and reducing unnecessary hospital readmissions and ED visits. In the years to come, ACOs will likely focus more on surgical care. Some ACOs have the ability to affect surgical practice patterns through referral pressures, but local market conditions may limit ACOs' abilities to alter surgeons' behavior. Policy makers, ACO administrators, and surgeons need to be aware of these trends because they have the potential to affect the surgical care provided to ACO patients as well as the success of ACOs themselves.
authors.affiliation: James M. Dupree (jim.dupree@gmail.com) was a health policy fellow at the American College of Surgeons, in Chicago, Illinois, at the time this research was conducted. He is currently a male reproductive medicine and surgery fellow in the Scott Department of Urology, Baylor College of Medicine, in Houston, Texas.
authors.forename: James M
authors.initials: JM
authors.lastname: Dupree
authors.affiliation: Kavita Patel is a fellow at the Engelberg Center for Health Care Reform at the Brookings Institution, in Washington, D.C.
authors.forename: Kavita
authors.initials: K
authors.lastname: Patel
authors.affiliation: Sara J. Singer is an associate professor in the Department of Health Policy and Management, Harvard School of Public Health, and a faculty member in the Department of Medicine, Harvard Medical School, and Mongan Institute for Health Policy, Massachusetts General Hospital, all in Boston.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Singer
authors.affiliation: Mallory West was a research assistant at the Brookings Institution at the time this research was conducted. She is now a senior associate at the Kinetix Group, in New York City.
authors.forename: Mallory
authors.initials: M
authors.lastname: West
authors.affiliation: Rui Wang is a medical student at Harvard Medical School.
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.affiliation: Michael J. Zinner is the Moseley Professor of Surgery at Harvard Medical School.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zinner
authors.affiliation: Joel S. Weissman is an associate professor at Harvard Medical School and in the Center for Surgery and Public Health at Brigham and Women's Hospital, in Boston.
authors.forename: Joel S
authors.initials: JS
authors.lastname: Weissman
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics / Q000458:organization & administration*; D003363:Cost Control; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D006278:Medicare; D019982:Organizational Case Studies; D010818:Practice Patterns, Physicians' / Q000191:economics; D012017:Referral and Consultation / Q000458:organization & administration*; D066231:Surgeons / Q000191:economics / Q000458:organization & administration*; D013514:Surgical Procedures, Operative / Q000191:economics; D014481:United States
keywords: Health Reform; Medicare; Organization and Delivery of Care; Physicians