John Venetos, MD, has been an independent physician since 1989 and is not planning on changing that anytime soon. Specializing in gastroenterology and hepatology, Dr. Venetos sees patients in his office with the help of three office staff on Chicago’s North Side and works out of multiple hospitals. His passion for staying independent and competitive in today’s environment while helping other doctors do the same led him to create Independent Physicians’ ACO of Chicago in 2012. With the goal of improving patient care and reducing health care costs, the accountable care organization (ACO) has developed from 100 members in the beginning to nearly 300 participating physicians today.
The ACO has grown through word of mouth and by working with leadership at provider organizations. Each physician contributes $500 to become an equal owner of the entity. “It’s the philosophy of what we did,” says Dr. Venetos. “No one is at a disadvantage, and the new joiners know they are just as important as those who have been members since the beginning.”
The ACO is governed by a board of directors comprised of 15 physicians – 10 primary care and five specialty providers – and two non-physicians that represent the interests of the entire group. Building trust within the network is essential. Members can rest assured that leadership has gone through the process of linking with the rest of the group and has successfully integrated into the ACO. They trust the board to provide proven strategies for improving patient care and lowering costs.
Dr. Venetos explains, “We knew if we were going to be successful at keeping doctors independent, we had to provide some value to the doctor and to the patients.” Members want to participate because they are getting something beneficial from the group. And reaping the benefits depends largely on the use of health IT. Making the most of an electronic health record (EHR) system is crucial, and meeting Meaningful Use (MU) is a big part of that.
The goal is to have all member doctors reach Stage 1 and Stage 2 of MU, which will be a very important measurement of the ACO moving forward. “Physicians know as they join that there will be someone to help them reach these goals,” says Dr. Venetos. Some doctors in the ACO are nearing retirement age and are willing to commit to learning to use an EHR effectively. Dr. Venetos continues, “If a player on the team is willing to commit, then I will do anything to help them be successful.” He also has reached out to CHITREC for assistance.
“The Chicago Health IT Regional Extension Center (CHITREC) has been wonderful at working with us and our practices to maneuver the waters of MU,” says Dr. Venetos. Sam Ross, CHITREC clinical implementation manager, has been critical. He helped several member doctors, attended open meetings, and provided useful info about MU measures and how to achieve them. “Some providers needed more help than others, and Sam was able to reach out to those who needed extra education,” explains Dr. Venetos.
While government incentive payments are a nice reward for working to achieve MU, Dr. Venetos believes the real motivator is the positive impact on patient care and quality improvement. “There are always bumps in the road, nothing’s perfect, but ultimately at the final destination we see all the benefits,” says Dr. Venetos.
Challenges ACO providers face on the path to meeting MU are often technological in nature. Some physicians have had difficulties with their EHRs due to software glitches or other issues. Others have had problems using their EHR on a laptop or syncing with Dragon, the speech recognition software. Some physicians went electronic but kept paper charts for some time while they became comfortable with the paperless system. “We need to go from point A to point B and make sure everyone gets there,” explains Dr. Venetos. “We create the pathways that are most successful and easy, knowing that not everyone takes the same pathway.” The ACO has been there to help providers navigate all these issues and Dr. Venetos has also called CHITREC for prompt answers that helped him troubleshoot difficulties.
One challenge for ACO leadership has been the incredible amount of time that is needed to support the membership. “It was not unusual to spend one and a half hours on a Sunday morning with a physician to train him on using an EHR,” says Dr. Venetos. “It is all worth it for the results we have gotten.” The ACO continues to be successful, in part because they put in the time it takes to teach others how to effectively use an EHR. Patients get better care and doctors have the tools to provide better care and stay independent. With trust and transparency, the ACO also brings to the doctors information and training on anything available that might help them – EHR systems, CHITREC, Dragon. “We’re a magnet and doctors come to us,” says Dr. Venetos.
“Comparing the year before I used EHR with the year after, I feel I am now a better physician,” says Dr. Venetos. He continues, “There’s better documentation, and patients are getting better care.”
If you are an independent physician, Dr. Venetos offers some advice for staying competitive in the current healthcare environment. “Practices should reach out to colleagues and see how they’re operating,” he says. “Look for opportunities that are out there, and look at other physician groups.” Also, Using an EHR company that has good customer support can help save time and resources. Dr. Venetos invites practices to “give us a call and come to our open meetings.” You can find out more about Independent Physicians’ ACO of Chicago at www.aco-chicago.com. The organization has physicians working out of all hospital systems. “The bond of doctors is not what hospital they are affiliated with, but the bond of independence.”