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AMGA Raises Red Flag on 'Burdensome' ACO Rules
Minimum Savings Requirements: "If you go back to the group practice demonstration, which was 10 medical groups over five years, they had a 2% minimum savings to meet before they got into the shared savings program. In the proposed ACO regulations they have taken that 2% and raised it to 3.9%. If you talk to most of the medical groups who participated in the group practice demo, they had a difficult time getting to 2% over a five-year window. Many of them invested a lot more money than they ever got back. So when you take this up to 3.9% you are requiring a huge hurdle to be overcome by these medical groups financially before they get into the shared savings."
AMGA is the latest in a line of professional provider organizations that has raised concerns about the proposed rules for ACOs. Earlier this week, the College of Healthcare Information Management Executives complained that the ability of patients in accountable care organizations to restrict access to their personal health information is one of several huge hurdles.
In April, a slate of health leaders including the CEOs of Scripps Health, Alegent Health, Kaiser Foundation Hospitals, and Dean Health Systems weighed in with their responses to CMS' proposed regulations.
In its letter to Berwick, CHIME called for a re-examination of several sections of the proposed rules that it said would create significant pressures on ACOs.
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Comments are moderated. Please be patient.
Daniel Connelly (5/13/2011 at 8:59 AM)
ACOs are an Obama supported initiative, first started as a concept in 2006. They are basically a rehash of the PPO with a few twists. The ACOs are promoted by Physicians for a National Health Program (PNHP) whose activist list in NJ is the unions. PNHP wants the bill HR676 passed to put everyone on medicare. Why would PNHP, the unions, and Obama liberals promote ACOs, when they really want medicare for everyone? ACOs are designed specifically to fail as an intermediate step to full government run socialized medicine. The following is the brief on how this would happen and I believe that it would happen quickly. 1. Hard working physicians are dazzled with the promises of the ACO. Collaborative, integrated accountable care will decrease overhead, improve care and decrease the work load of physicians. That's the bait. 2. Down play the transfer of "risk" from the insurance companies, the union plans, and the government to the ACO. That's the trap. 3. The ACO becomes the defacto insurance company with all attendant risks, no multimillion dollar reserve or the ability to print money. 4. The physician is torn being the patient advocate and the insurer delayer/denier of claims. Deny a claim (demand for service) and get sued. Be the patient advocate and don't deny claims, the ACO becomes insolvent, bankrupt, financially unviable. 5. The federal government steps in to save the failing ACOs and incorporates them into the national system, along with all the business assets 6. With most of the medical business assets,(people,equipment, offices and hospitals) under federal ownership, a private system will not be allowed to, or be able to reconstitute.