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ACO Rules Receive Guarded, Mixed Reviews

 |  By John Commins  
   April 04, 2011

The federal government’s long-awaited proposed rules governing accountable care organizations have received guarded and mixed reviews from healthcare providers, who were still reading through the 490-page proposal in the hours after its recent release.

Most groups issuing statements about the new rules have professed their support for the concept of ACOs, but say they will reserve judgment until after reading through the implementation details.

“This is an historic effort among government agencies to achieve the goal of better coordinated care," says Linda Fishman, senior vice president for Policy at the American Hospital Association. “It provides a path forward to provide accountable care and supports the direction that the hospital field is already moving toward better coordinated care for patients.  However, it does not go nearly far enough to eliminate the barriers to clinical integration among caregivers.”

Jeremy A. Lazarus, MD, speaker of the American Medical Association House of Delegates, reaffirms that “ACOs offer great promise for improving care coordination and quality while reducing cost, but only if all physicians who wish to are able to lead and participate in them. For this to happen, significant barriers must be addressed, including the large capital requirements to fund an ACO and to make required changes to an individual physician's practice, existing antitrust rules and conflicting federal policies.”

America’s Health Insurance Plans President/CEO Karen Ignagni offers the same concern about the details in the implementation. “We remain concerned that ACOs could accelerate the trend of provider consolidation that drives up medical prices and result in additional cost-shifting to families and employers with private coverage,” Ignangni says.

William F. Jessee, MD, president/CEO of the Medical Group Management Association, says the “complexity” of the ACO proposal was “significant” and warranted detailed review. “With multiple agencies proposing rules on the same topic, physician practices need to thoroughly examine how participation in ACOs may affect their practice operations,” Jessee says. “MGMA and our members will develop specific feedback to CMS and the other agencies to ensure that any overly restrictive or administratively burdensome requirements are addressed so this well-intended concept can become a practical reality."

The Obama Administration has said that ACOs could save Medicare as much as $960 million over three years. Before the proposed rule is finalized, however, the Centers for Medicare & Medicaid Services will review all comments from the public and may make changes to its proposals based on those comments, the Department of Health and Human Services said.

HHS Secretary Kathleen Sebelius expressed confidence that ACOs would 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. “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 Medicare Shared Savings Program initiated under the Affordable Care Act will reward ACOs that lower healthcare costs while meeting performance standards on quality of care and patients’ need.

Under the proposal, ACOs – teams of doctors, hospitals, and other healthcare providers and suppliers working together – would coordinate care for patients with Medicare. To share in savings, ACOs would meet quality standards in five key areas:

  1. Patient/caregiver care experiences
  2. Care coordination
  3. Patient safety
  4. Preventive health
  5. At-risk population/frail elderly health.

The proposed rules also include protections to ensure patients do not have their care choices limited by an ACO, HHS said.

If ACOs save money by improving access to primary care so that patients can avoid a trip to the emergency room, for example, the ACO can share in those savings with Medicare. ACOs that do not meet quality standards cannot share in program savings, and over time, those who do not generate savings can be held accountable.

“An ACO will be rewarded for providing better care and investing in the health and lives of patients,” said Donald M. Berwick, MD, CMS Administrator. “ACOs are not just a new way to pay for care but a new model for the organization and delivery of care.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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