ACO Concerns Elicit Enticements from CMS' Berwick

"Some of the early comments on the proposed rule suggest that some providers lack the capital they need to invest in the infrastructure, like information systems and staff for care coordination," Berwick said. Under this second option, "providers who lack access to capital could make those investments under the idea of an accelerated payment program by accessing shared savings early."

Organizations now participating in CMS' Physician Group Practice (PGP) demonstration projects would not be precluded from joining in as "pioneers," Berwick said.

"PGP sites are quite suitable in terms of the competence and experience to be pioneers, if they choose to," he said. A link to the "Pioneer" application rules and procedures is here.

The agency is requesting comments from providers on the advance payment model proposal by June 17.

The third enticement comes in the form of education and training. The agency is organizing a series of four free Accelerated Development Learning Sessions, which Berwick says should be useful in giving providers access to knowledge and expertise to set up their own ACOs. The sessions will include explanations on core competencies such as improved care delivery to increase quality and reducing costs and using health information technology and data resources.

Berwick acknowledged the volume of concerns providers have expressed about the first ACO model, saying his agency has been "listening closely to input from all sorts of stakeholders so we can modify and improve the proposed rule into an even better final rule."

But he cautioned that the task is a "very challenging job because the ground rules for ACOs have to strike careful balances in a number of dimensions. For example, they have to give providers incentives to achieve savings, and tools, to help coordinate and improve care.

"We also need to make sure that providers don't stint on care or withhold care when it's needed in pursuit of those incentives."