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ACO, MLR Specters Haunt Providers, Employers

Cora Nucci, for HealthLeaders Media, October 6, 2010

October has only just begun, but fears about healthcare reform are multiplying like swooning teens at a vampire flick. The Patient Protection and Affordable Care Act is freighted with anxiety-inducing provisions that are eliciting angst in all quarters.  No one, it seems, is spared:  not providers, not health plan executives, not employers, and not the public.

At a public meeting in Baltimore Tuesday, officials from the Centers for Medicare & Medicaid Services and the Federal Trade Commission tried to quell the concerns of health insurance executives and healthcare providers over accountable care organizations.  Doctors and hospitals worry that by forming partnerships to deliver coordinated quality care to a select group of patients for set fees, they could potentially violate antitrust and anti-fraud laws.  Federal officials tried to reassure them:

"From an antitrust perspective, we want to explore whether we can develop safe harbors so doctors, hospitals, and other medical professionals know when they can collaborate and when they cannot," FTC Chairman Jon Leibowitz said in opening remarks at Tuesday's FTC/CMS Workshop on ACOs.

Providers aren't alone in their apprehension.  Health plan executives fear that ACOs will only push costs higher.  And since no single, agreed upon ACO payment structure yet exists, they may be right.

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