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13 Hot ACO Buzzwords All Providers Should Know

Cheryl Clark, for HealthLeaders Media, April 6, 2011

By now, of course, all hopeful Accountable Care Organization providers have studied all 429 pages of the long-awaited proposed ACO regulations released Thursday by the Centers for Medicare & Medicaid Services. We don't mean to insult your intelligence or capability. 

But just in case you missed a few spots, here's a quick-term glossary, culled from the nearly 116,000-word document , as well as the accompanying 8,700-word proposed statement on the ACO anti-trust enforcement policy from the Department of Justice and the Federal Trade Commission .

These proposed regulations contain multiple caveats, codicils, and exceptions. Observers are sure much of what has been proposed will be changed when the final rules are eventually published later this year.

There's plenty of time for the public to voice concerns or other comments. Deadline for those is May 31. And the date for qualified ACOs to begin is Jan. 1, 2012. Until then, it would be wise to understand the terminology.

1. The Paperwork Reduction Act of 1980 or PRA. The proposed ACO rules specifically say that the PRA, which strives to minimize the paperwork burden resulting from the collection of information by or for the Federal Government, would not apply to ACOs.

This is, in part, because rather than specifically having patients opt-out of some provisions, such as electronic information sharing, each participant will "opt-in," likely creating more forms to fill out, document and store.

2. Safety Zone. Think safe harbor. This is the promise that federal anti-trust agencies, "absent extraordinary circumstances" will not challenge the eligibility of an entity that meets other ACO criteria if its provider participants fall into this safety zone. To do so, they must have a combined share of 30% or less of each common service in an ACO participant's primary service area (PSA). 

The zone is extended for ACO participants who have between 31 to 50% share of a common service area, "if it avoids specified conduct." A greater than 50% share, however, constitutes "a valuable indication of an ACO's potential for competitive harm." There are exceptions for providers in Rural Service Areas (RSA).

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