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Aurora Health Balks at ACOs Under Proposed Rules

John Commins, for HealthLeaders Media, May 18, 2011

Aurora Health Care President/CEO Nick Turkal, MD, says the Milwaukee-based healthcare system will not take part in the federal government's Accountable Care Organization pilot projects unless significant changes are made to the proposed rules.

Turkal told HealthLeaders Media that the proposed rules issued last month by the Centers for Medicare & Medicaid Services create a program where risks outweigh rewards.

"We had been very excited about the concept of ACO and Aurora has been designed around the concept of accountable care. But the pilot as designed by CMS doesn't match with what we expected and I don't think it matches with what a lot of providers expected across the country," Turkal said.

The Aurora Health chief joins a growing chorus of healthcare providers who are raising concerns about key components of the proposed rules, and says he plans to send a letter to CMS before the end of the comment period, pointing out his concerns and providing a list of recommendations.

Turkal said he believes the concerns he has for the ACO proposed rules are widely shared by other healthcare providers, particularly the capitation schedule that puts ACOs at risk in the third year.

"If you look at the end game, what are we trying to accomplish with an ACO pilot? I think what we are asking is 'is the model that is out there now going to get us there?'" he explained. "We think the answer may be 'no,' that it is designed in a way that moves a little too quickly towards capitation for many markets, and that has a quite rigid approach to quality and efficiency."

"If you move too many markets too quickly to capitation, then you haven't allowed the time for adjustment for patients, for physicians, for hospitals, to make that move in a way that doesn't impair quality or service to patients, or become just a huge financial burden," he continued.

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