American Medical Group Assn. Cites Issues With Accountable Care Rules
On Wednesday, the American Medical Group Association -- a trade association that represents major multi-specialty health organizations such as the Mayo Clinic and the Cleveland Clinic -- warned CMS that 93% of the organization's members will not participate in the Medicare Shared Savings Program as currently written, CQ HealthBeat reportsÂ (Adams, CQ HealthBeat, 5/11).
In March, CMS released its proposed shared savings rule, which would govern the new accountable care organizations encouraged under the federal health reform law. Lawmakers intended that networks of providers would form ACOs to collaborate on care for Medicare beneficiaries, improve outcomes, reduce cost and share in savings.
In the rule, CMS laid out two models for ACOs -- one for organizations that are "earlier in their evolution" toward becoming ACOs and one for organizations that are willing to assume greater risks.
In a letter sent to CMS Administrator Donald Berwick, AMGA President Donald Fisher said that members are concerned that the proposed program "is overly prescriptive, operationally burdensome, and the incentives are too difficult to achieve to make this voluntary program attractive."
AMGA members also were wary of the program's risk sharing requirement, retrospective patient attribution, static risk adjustment, quality measurement requirements and the Minimum Savings requirement (Pecquet, "Healthwatch," The Hill, 5/11).
Fisher notes that members could end up participating in the program if significant changes are made (CQ HealthBeat, 5/11). However, "we're really talking about significant changes being needed; it's not just a matter of a tweak here and a tweak there," he says (Daly, Modern Physician, 5/11).
Some of the changes that Fisher suggests include:
- Not requiring providers to face financial risk if they join the program but fail to save money;
- Lowering the threshold for savings;
- Adjusting for sicker patients each year, rather than just once; and
- Informing providers earlier which patients are part of the ACO (CQ HealthBeat, 5/11).
If CMS does not make changes to the rule, Fisher warns that the administration would be wasting "the best opportunity to inject value and accountability" into the health care system ("Healthwatch," The Hill, 5/11).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.