Answers on ACOs

ACO proposed rules spotlight physician-hospital alignment

For at least one analyst, there are plenty of details in the sweeping 429-page proposed guidelines for accountable care organizations the Centers for Medicare & Medicaid Services issued March 31.

“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 noted 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, the 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.

Healthcare industry groups have offered guarded support for ACOs, but are still sifting through the details. America’s Health Insurance Plans, for example, has raised concerns that hospitals and ACO collaborations could forge monopolies for their service areas and dictate higher prices.

Keckley says the proposed guidelines attempt to deal with the “unforeseen.”