Pro-con debate - ACOs are, or are not, good for the practicing allergist - Twitter summary from 2013 #AAAAI meeting

This summary was compiled from the tweets posted by allergists/immunologists who attended the 2013 annual meeting of the American Academy of Allergy Asthma and Immunology (AAAAI) (see the list at the end). The tweets were labeled #AAAAI. The text was edited and modified by me. This is the last edition of the 2013 series. You can see the rest of summaries here.

Pro-con debate - ACOs are, or are not, good for the practicing allergist

Daniel Ein was con, Michael Foggs was pro in ACO debate.

Dr Ein’s Definition: ACO is a legal entity composed a group of providers that assume responsibility for management/care in an effective/efficient manner. ACOs have 2 main functions - delivery of care and administration of care. Administrative functions can be farmed out to health management organizations such as MSO.

ACOs can include various specialists or can contract out their services. Hospitals have to be involved, at least as partners - But Incentives of hospitals are different than those of providers. 2.4 million have been enrolled in ACOs as of Nov 2012. There are 4 times more private ACOs than Medicare ACOs.

Do ACOs reduce costs? Evidence from really only 1 study (a shared-saving program) JAMA 308:1015. Annual savings were modest ($114 per year per patient), all showed reduced hospitalizations/ED visits though. ACOs may not really be worth the substantial effort.

Dr Foggs (pro): His group, Advocate, has been buying up numerous practices, including specialties. He says ACOs put allergists in a precarious position unless we change we'll be extinct. And he's on the pro side! Allergists need to align themselves with these large groups to save themselves and the practice of allergy.

The 3 building blocks of the new system are ACOs, medical home and EHR. Solo or single specialty groups will be difficult in the future.

Risks of non-participation include: further encroachment by ENT/pulmonary and less reliance of PCPs on your services.

How to get involved - get more active in your hospital. Upsides of involvement: maintain and expand your referral base, no immediate changes in FFS.

Merging with other allergists or forming an IPA may help maintain some independence.

PCPs have to be involved with only one ACO, specialists can be in multiple ACOs but if a patient comes to you for most of their care and doesn't have a PCP, then you could be designated as their PCP and only eligible for one ACO.

Dr Ein: Would u join an org that might reduce your reimbursement, that would make you share in possible losses, that might go bankrupt, that would dictate to you how to practice, what's the rush?

Allergists are on Twitter - follow them

Allergists increased Twitter use 470% in one year - 25 allergists reached 250,000 individuals from the 2012 #AAAAI meeting (see the references here). This summary was compiled from some of the tweets posted by the following allergists:

This is a list of the allergists who used Twitter to post updates from the 2013 #AAAAI meeting. The list is open for edit, please feel free to add your own info.

I would strongly encourage you to post updates on Twitter from the CME conferences that you are planning to attend in the future. Here is how to do it: Twitter for Physicians: How to use Twitter to keep track of the latest news and scientific meetings, and share information with colleagues and patients.

Disclaimer: The text was edited, modified, and added to by me. This is one of a series of posts that will be published during the next few weeks.

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