Proposed ACO Rules Attract Public Gripes

Families USA
A rare upbeat comment came from Michaelle Gady, health policy analyst with Families USA, a voice for healthcare consumers.

Gady said her group is "pleased with the high bar that CMS set in the proposed rule and strongly urge CMS to maintain the robust quality improvement and consumer protections in the final rule."

However, even Families had a long wish list of items CMS should change in the 20 pages that followed, one of which is to require two Medicare beneficiary representatives sit on the governing body of every ACO for every 5,000 patients assigned. Without a specified representation number, having a beneficiary advisory panel or committee alone, which the rule proposes, "is inadequate on its own, in providing for appropriate patient participation in ACO governance."

The American College of Physicians
Representing 130,000 internal medicine providers, many of whom would guide these ACOs, The American College of Physicians, expressed other objections.  "The current requirement...sets too high of a bar for participation by many internal medicine physicians, especially...in primary and comprehensive care of adults who practice in smaller, independent, physician practices."

Even large physician groups that are "already organized under an ACO-like structure that already have ready access to capital, substantial infrastructure development, and experience operating under an integrative service/payment model (e.g. Medicare Advantage)...have questioned the 'business case' for adoption." 

However, the ACP said it likes the idea of the Pioneer model that would relax some rules and provide for some 'advance payment' mechanisms for smaller practices.

The AMA
The American Medical Association's executive vice president Michael Maves, MD, addressed the anti-trust provisions of the proposed rules governing ACOs. 

"Physician-led ACOs are a necessary option because the savings generated by ACOs in many cases are expected to result from reduced inpatient admissions, and this requires physician leadership outside of a hospital," he wrote. "Accordingly it is important that the antitrust rules create a level playing field that does not favor hospitals over physician-led ACOs."