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CMS Listening, Trying with Adjustments to ACO Rules

Philip Betbeze, for HealthLeaders Media, May 20, 2011

Scores of well-respected health systems have complained that accountable care organization regulations are too stringent, too restrictive, and above all, too risky to consider participating at this point. That’s because they require substantial investment in capital and labor without a guarantee of a return on that investment.

Even given the declining future of a fee-for-service reimbursement structure, CEOs have concluded that it’s more predictable to stick with what you know, given the alternative, than to jump aboard the Medicare ACO train before it’s really ready to leave the station.

At least CMS is listening. Already, after only a month and a half of carping—both in public forums like HealthLeaders as well as, presumably, in private conversations with CMS movers and shakers like CMS head Don Berwick—hospital and health system leaders have already pushed the agency to at least partially change the requirements of participating in a Medicare ACO.

This week, CMS unveiled a new three-track process to win adherents, and ultimately, it hopes, broad participation in the program. One track consists of three-day learning sessions to be staged in four sessions around the country.

I encourage you to look at my colleague Cheryl Clark’s fine analysisof the changes that are being made in the rules. From her excellent work in getting candid responses from hospital and health system leaders, it looks as though even the changes announced this week might not be enough.

This kind of carping from major health system leaders only underscores the huge difficulty --some might say impossibility -- of attempting to create a one-size-fits-all solution to the challenge of high healthcare costs and associated poor quality in a cottage industry such as healthcare.

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