ACO Final Rules Ease Requirements, Reduce Risk
Officials for the American Medical Association, the American Hospital Association, and the Premier Healthcare Alliance, a quality and purchasing group representing 2,500 hospitals, say they think the numerous revisions will make more hospitals and doctors willing to partner to coordinate care and save Medicare spending.
"We were very pleased at the changes the anti-trust agencies made to the ACO rule, said Linda Fishman, Senior Vice President for Policy for the AHA during a news briefing. "This is a big win for hospitals because they eliminated the requirement that you must pass muster with anti-trust agencies, so anti-trust will no longer be a barrier to participation."
Peter Carmel, MD, President of the American Medical Association, said in a statement that his organization also is pleased. "This rule allows ACOs to share in every dollar of cost savings and includes an option that limits financial risk, which is important for many physician practices.
However, several healthcare leaders who have followed the evolution of the ACO rules say they still have some major disappointments.
"We are troubled that the agency has chosen to move forward with an unworkable plan to allow beneficiaries to participate in the ACO, but also opt-out of sharing the data," Premier said in a prepared statement. "Without access to beneficiary data, ACOs will be hamstrung in efforts to target interventions that are essential to improve care quality, provide convenient choices and enhance overall compliance with recommended care."
This "rigidity," the purchasing groups said, "could have the unintended consequence of limiting necessary services that would enhance compliance with treatment plans, and compromise the ACO’s ability to achieve the goals of better health, better healthcare and reduced expenses."
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