For the past couple of years, the ACR Future Trends Committee has been tasked with developing strategies and tools to help radiologists become part of accountable care organizations — one of the shared savings programs in the Affordable Care Act that's intended to improve care for patients.

Fast forward to today, and many radiologists are still unsure how they fit in to ACOs. Nonetheless, many are technically a part of an ACO, although imaging as a whole has still not been written into the ACO structure.

"There aren't 300 examples of radiologists being in a comprehensive ACO and behaving as if they are in one, where all their work is now at risk," Dr. Frank Lexa, a professor in the department of radiologic sciences at Drexel University in Philadelphia, told DOTmed News.

While the ACA has created interest in and opened the door for ACOs in the private sector, it specifically created an ACO program in the public sector: the Medicare Shared Savings Program (MSSP). There is also the Pioneer ACO program that's a part of Medicare, but designed to be more flexible in nature. A recent study in the journal Health Affairs found that hospitals were participating in slightly less than half of the initial group of the public sector ACOs.

According to national figures, there are roughly 300 private ACOs, and roughly the same number of Medicare ACOs across the country. Many hospital systems — like Kaiser Permanente or even Montefiore Medical Center in New York — already functioned like an ACO even before the term was coined. These institutions have an integrated delivery system with technology built in to coordinate patient care, as well as a payment arrangement with health plans that includes financial accountability and performance incentives.

"To borrow someone else's quip: Many radiologists didn't even know they were in an ACO because nothing changed," said Lexa.

That might be seen as a good thing for some who are happy to know radiologists are in the mix, but a disappointment to others who feel radiologists need to be more involved.

Lexa said that the flexible nature of the private ACOs, and that fact that they are still evolving, is an opportunity for radiologists to do just that — get involved.

"The biggest message from ACO diversity so far is that they're an opportunity to craft your own contract or your own relationship and consider ways that you might make an offer," said Lexa.

He hopes radiologists will go beyond working as contractors in ACOs that only provide imaging services.

"Ultimately, your pay in the future is going to be a part of this," said Lexa.

While ACOs will likely be tweaked through the years — especially the federal ones — returning to the days of fee-for-service is unlikely, according to Lexa.

"Whether you like ACOs or not, it's kind of a kick to get you to wake up, to figure out how we can get paid for value and can do a better job measuring outcomes," he said.

NOTE FROM EDITOR: Are you a part of an ACO or do you have experience with one? If so, please let us know below. I'll write a follow up story based on your responses.

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