Proposed ACO Rules Attract Public Gripes

Cheryl Clark, June 9, 2011

It's no surprise that controversy would badger the Centers for Medicare & Medicaid Services revolutionary accountable care organization concept. Any complex regulation exceeding 400 pages and requiring providers to form teams and accept an altered payment model stands to take some heat.

Just days after the proposed rules were released in April, Scripps Health president and CEO Chris Van Gorder told HealthLeaders Media, "Frankly I was surprised. I thought there would be more carrots, not so much stick."

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And as the period closed June 6 for public comments on CMS' proposed rules governing these new models of care, Van Gorder had plenty of company. Few provider groups or individuals had any nice things to say, save a platitude or two commending the agencies for taking on the effort.

At least 800 comment documents were filed on pertaining to CMS' purview over the ACO program.  Additional comments were filed to the Department of Justice, Office of Inspector General, Federal Trade Commission and Internal Revenue Service addressing their authorities and concerns about ACO legality and compliance.

The comments posted on are as varied as they are expressive and as long-winded and detailed as they are pithy. We chose a sample from a few that raise a constellation of concerns. Some, apparently speaking as individuals, are particularly pointed:

Why are nurse practitioners excluded from the Accountable Care Organization regulations?" wrote Carolyn Dollar of Family Health Care Clinics in Mississippi. "Do you have any idea what that will do to access to care in rural Mississippi and I dare say other rural states as well? I currently work in two rural clinics that do not have a physician present. My patients will have nowhere to go locally for healthcare if this regulation using only physicians as providers passes. I am hopeful that this will be seriously reconsidered.

"I'm not interested in this type of healthcare," wrote Margaret Bowlander of New York. "It will cost us more in the long run financially and care will be less. I don't plan on this horrible program to pass and am calling on God's name despite you trying to take Him out of everything."


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