8. Paul Keckley, executive director of the Deloitte Center for Health Solutions:
"They heard from medical groups – that we could do a lot of this if you made this one-side model a little more attractive – we're not interested in the two-side model – and if you let us focus on a few populations that we can manage instead of populations like the frail elderly, where you're requiring us to have the hospital sit at the table with us.
"If there's a subtlety here from CMS, it's that they sent a message that they're focused on care coordination that's physician-driven.
"They are focused on roles that hospitals or plans could play. But the ACO is largely about how doctors manage care. Period. How they clinically integrate, share risk, and manage care. And as you know, there aren't many communities where doctors work together so well. That's going to be the fun part of this."
"I'm imaging how Don [Berwick, CMS administrator] and Marilyn [Tavenner, Berwick's principal deputy] have been working on this and my sense is that there really was an effort to put a face on CMS as a 'listener.' "
9. Peter Carmel, MD, president of the American Medical Association: "The AMA asked for ACOs to report on a lower number of quality measures that were most relevant to their patient populations and for removal of the measures associated with hospital-acquired conditions. The final rule reduces the number of required measures by half, including removal of the HAC measures, but the AMA would have preferred even greater flexibility on which measures practices are required to report.
10. Joseph Kvedar, MD, founder and director of the Center for Connected Health:
On the elimination of the requirement that 50% of the physicians in an ACO qualify for electronic health record meaningful use," I don't necessarily think that's a bad idea because I can't imagine anyone [creating an ACO] without an EHR.
"What's being required of us to be an accountable care organization is a tremendous level of coordination. And God knows we'll need many more technologies than just EMRs. That's the baseline. So in a way it makes sense for them not to have to prescribe that. If we're stupid enough to try without it, then let the chips fall where they may."