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ACO Proposed Rules Spotlight Physician-Hospital Alignment

John Commins, for HealthLeaders Media, April 5, 2011

For at least one analyst, there are plenty of details but not too many surprises in the sweeping 429- page proposed guidelines the Centers for Medicare & Medicaid Services issued last week on accountable care organizations.

"The deliberate process they took to issue this two months after we expected it shows they were being very cautious," said Paul Keckley, executive director of the Deloitte Center for Health Solutions, in an interview with HealthLeaders Media. 

"They were very deliberate in the language. I've read it twice. The amount of effort they built into calibrating the quality metrics, the indices of the five domains, the waivers, the safety zones, the antitrust issues. They were pretty thoughtful about balancing all of those moving parts of what is a pretty complicated concept," he says.

Keckley said that anyone who's been following the ACO movement wouldn't be surprised to note that the overarching concern in the guidelines is physician-hospital alignment.

"You have value-based purchasing, and episode-based payments and avoidable readmissions, and the medical home, the ACO, physician quality reporting initiative and the physician self-referral language and you step back and see they are compelled by the vision of integrated systems," he says. "That to me is the big cake here."

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