But Chung acknowledged potential concerns too. “Psychiatrists may wonder whether higher levels of screening will lead to higher levels of depression diagnosis resulting in them getting inundated with new patients,” he said. “If ACO participation leads to waiting lists and disappointment, that is not good.”
But not only will ACOs stimulate the linking of primary care physicians and psychiatrists, they will promote professional bonding between specialists and psychiatrists. That is the case at Norton Healthcare, which is one of the 5 physician group/hospital combinations participating in an ACO pilot program under the aegis of the Dartmouth Institute for Health Policy & Clinical Practice and Brookings Institution. Norton is using patients assigned to its ACO by Humana and using Dartmouth/Brookings established quality yardsticks. It is not one of the “pioneer” ACOs designated by Medicare.
Mary Helen Davis, MD, is Director of Behavioral Oncology at Norton, so she sees only oncology patients, including those assigned to the Norton ACO. It is a different way to practice for a psychiatrist such as Davis, who previously was at an academic medical center for 12 years and in private practice for 8 years. She only works with oncology patients and their 30 oncologists in a fully integrated oncology practice. “There has been a big push for integration of psychosocial service standards into the practice of oncology and a resulting emphasis on screening for distress and providing an appropriate intervention for identified problems,” she explained. “There has to be a way to get that patient quick access to mental health services and sometimes a psychiatrist, either internally or externally.” External access, or referral to a psychiatrist in the community, can be problematic because of regional shortages of psychiatrists, particularly those willing to accept third-party reimbursements.
Like Montefiore’s Chung, Norton’s Davis noted that psychiatrists face pitfalls and opportunities in terms of ACO participation. They may be viewed by management as revenue depressants. “Psychiatry has to be seen as more than a reimbursed clinical service,” Davis emphasized. “In the hospital system, it is not likely to be a leading revenue generator, so administration and hospital leadership need to view psychiatric services as value added.”