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ACO Rules Receive Guarded, Mixed Reviews

John Commins, for HealthLeaders Media, April 4, 2011

The federal government’s long-awaited proposed rules governing accountable care organizations have received guarded and mixed reviews from healthcare providers, who were still reading through the 490-page proposal in the hours after its recent release.

Most groups issuing statements about the new rules have professed their support for the concept of ACOs, but say they will reserve judgment until after reading through the implementation details.

“This is an historic effort among government agencies to achieve the goal of better coordinated care," says Linda Fishman, senior vice president for Policy at the American Hospital Association. “It provides a path forward to provide accountable care and supports the direction that the hospital field is already moving toward better coordinated care for patients.  However, it does not go nearly far enough to eliminate the barriers to clinical integration among caregivers.”

Jeremy A. Lazarus, MD, speaker of the American Medical Association House of Delegates, reaffirms that “ACOs offer great promise for improving care coordination and quality while reducing cost, but only if all physicians who wish to are able to lead and participate in them. For this to happen, significant barriers must be addressed, including the large capital requirements to fund an ACO and to make required changes to an individual physician's practice, existing antitrust rules and conflicting federal policies.”

America’s Health Insurance Plans President/CEO Karen Ignagni offers the same concern about the details in the implementation. “We remain concerned that ACOs could accelerate the trend of provider consolidation that drives up medical prices and result in additional cost-shifting to families and employers with private coverage,” Ignangni says.

William F. Jessee, MD, president/CEO of the Medical Group Management Association, says the “complexity” of the ACO proposal was “significant” and warranted detailed review. “With multiple agencies proposing rules on the same topic, physician practices need to thoroughly examine how participation in ACOs may affect their practice operations,” Jessee says. “MGMA and our members will develop specific feedback to CMS and the other agencies to ensure that any overly restrictive or administratively burdensome requirements are addressed so this well-intended concept can become a practical reality."

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