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AMGA Raises Red Flag on 'Burdensome' ACO Rules

John Commins, for HealthLeaders Media, May 13, 2011

Fisher told HealthLeaders Media that he is disappointed that CMS didn't use the lessons learned from the group practice demonstration project. "These requirements to become an ACO are much more stringent that what the group practice folks had to go through, and at the end of their five-year period they were able to demonstrate that they improved outcomes and saved money," Fisher said. "Why would you want to raise the bar even higher for the next level of participants in this experiment. The 2% minimum savings was the maximum for the group practice demo folks. Now we have raised it to 3.9%. They did have retrospective attribution and that was a real problem for them and they complained. We were hoping CMS would fix it, but they didn't."

Fisher said AMGA hopes to work with CMS to revise the rules, but AMGA is also prepared to go to Congress to ask for help if CMS is unwilling or unable to amend the rules. "This is the real opportunity in the Affordable Care Act to reform the healthcare delivery in this country. We want to see it work," he said.

 
See Also:

Leaders Respond to CMS' Proposed ACO Regulations
The Leap to Accountable Care Organizations
The Bridge to Accountable Care Organizations


John Commins is a senior editor with HealthLeaders Media.

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1 comments on "AMGA Raises Red Flag on 'Burdensome' ACO Rules"


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.