Lisa Rotenstein, MD, MBA, Co-Authored NEJM Perspective on Why ACOs Have Failed Primary Care Physicians
Lisa Rotenstein, MD, MBA, of DoC-IT, together with Nicolas Stine, MD, of UCSF, and Bruce Landon, MD, MBA, of Beth Israel Deaconess Medical Center, has published a Perspective article in the New England Journal of Medicine. “Why Shared-Savings ACOs Have Failed to Deliver for Primary Care” examines why accountable care organizations (ACOs) have not delivered on their early promise for primary care physicians (PCPs), and what leaders can do differently.
ACOs rely on PCPs to manage patients’ overall care and meet quality targets. The authors note that ACO models have made PCPs accountable without providing them with the authority, resources, or additional compensation to succeed. Primary care accounts for just 5% of Medicare spending, yet it has an outsized influence on patients’ care trajectories and outcomes. Many ACOs sit inside hospital-centric health systems whose revenue still depends on higher service volume, which puts PCPs between competing priorities. Heavy investment in coding intensity, which does little for patient care, adds to the demoralization.
The authors propose four steps:
- Direct resources to primary care.
- Give PCPs operational authority and infrastructure.
- Use risk measures that reflect clinical complexity without adding administrative burden.
- Monitor the primary care workforce.
“Primary care is central to value-based care and ACO success,” the authors write. Future models, they conclude, must close the gap between what PCPs are asked to do and the systems and economics that support them.