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Roundup: ACO Proposed Rules Fuel Uncertainty

John Commins, for HealthLeaders Media, April 8, 2011

The pacing, the toe tapping, and the finger drumming ended last week for an anxious and expectant healthcare industry when the federal government – two months overdue – finally delivered its much anticipated 429-page proposed guidelines for accountable care organizations.

And even though the ACO program is voluntary and will be limited to only about five million Medicare beneficiaries when it opens on Jan. 1, 2012, there remains a sense among supporters and detractors that there is no going back – that no matter what happens during the ensuing public comment period, the healthcare world has changed forever.

When the proposed guidelines were released last Thursday, Health and Human Services Secretary Kathleen Sebelius boldly stated that ACOs will put patients and their doctors “in control” of their own healthcare. “For too long, it has been too difficult for healthcare providers to work together to coordinate and improve the care their patients receive,” Sebelius said, in the HHS media presentation. “That has real consequences: patients have gaps in their care, receive duplicative care, or are at increased risk of suffering from medical mistakes. Accountable care organizations will improve coordination and communication among doctors and hospitals, improve the quality of the care their patients receive, and help lower costs.”

The major healthcare lobbying groups offered noncommittal – and possibly prefabricated – immediate reactions to the guidelines – saying just enough to appease befuddled journalists asking fuzzy questions about a concept that many clearly do not yet understand, and careful enough to avoid aggravating the federal policyholders they’ll attempt to sway during the coming public comment period, but also reasserting their longstanding concerns about the impact of ACOs on their corner of the healthcare market.

 “This is an historic effort among government agencies to achieve the goal of better coordinated care," said Linda Fishman, senior vice president for Policy at the American Hospital Association, in a statement issued soon after the guidelines were made public. “However, it does not go nearly far enough to eliminate the barriers to clinical integration among caregivers.”

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