Health Care Providers Convey Concerns About Proposed ACO Rules
The providers are most concerned with provisions that are intended to keep ACOs from increasing Medicare spending, which they say could end up costing rather than saving money if the providers do not reach saving targets (Feder, Politico, 5/24).
ACOs, mandated by the federal health reform law, aim to lower costs and improve care by fostering cooperation between physicians, hospitals and other providers.
The overhaul requires federal health programs to begin contracting with ACOs starting in January 2012. In addition, health care executives plan to form similar organizations through private insurance. HHS estimates that ACOs will save Medicare between $510 million and $960 million during the first three years.
According to the proposed rules, groups of care providers can qualify as ACOs when they are able to provide primary care for at least 5,000 patients. In order to achieve savings, they also must meet 65 quality standards.
The government will allow two months for public comment before issuing the final rules (California Healthline, 4/1).
Health Care Providers' Concerns
According to Politico, health care providers' stance puts the Obama administration in a difficult position. As federal officials receive feedback during the public comment period, they must weigh whether to make the rules stricter or more lenient.
The success of the ACO program hinges on their decisions, Politico reports. If the rules are too strict, providers would be unable to achieve the quality standards and would not participate. However, if the rules are too loose, ACOs would not garner the type of savings the administration predicted.
For now, CMS officials say they are not concerned about the criticisms.
Richard Sorian, HHS assistant secretary of public affairs, said that CMS is "100% confident that [ACOs] will be established on schedule, improve the quality of care and lower costs."
Meanwhile, CMS Administrator Donald Berwick said the providers' criticisms are part of developing a final rule. "It's a comment period. We will meld all that input into a final rule," he said.
However, Politico reports that some of the provisions that health care providers are most concerned about were included at the insistence of the Office of Management and Budget, which could make them difficult to alter (Politico, 5/24).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.