Several Groups Submit Last-Minute Comments on Proposed ACO Rules

On Monday, several groups submitted comments on proposed rules governing the creation of accountable care organizations under the federal health reform law, just hours before the public comment period on the regulations closed, CQ HealthBeat reports (Norman, CQ HealthBeat, 6/6).

Background on ACOs

The overhaul requires federal health programs to begin contracting with ACOs starting in January 2012. They aim to lower costs and improve care by fostering cooperation between physicians, hospitals and other providers.

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.

Previous Feedback

Most of the reactions posted during the comment period were negative. Some organizations have argued that the management of ACOs should be simplified. They said that the rules create too many bureaucratic and legal hurdles and that the number of quality standards will require excessive data management. Other groups are worried that potential savings are limited, especially when considering startup costs (California Healthline, 6/6).

Families USA Comments

Advocacy organization Families USA submitted comments on the rules, praising the Obama administration for taking a "balanced approach" that emphasizes patients' needs, CQ HealthBeat reports.

Michealle Gady -- a health policy analyst who submitted the Families USA comments -- wrote, "While some stakeholders are concerned about asking too much of ACOs and individual providers, we believe that they must be held to a standard that is high enough to ensure they deliver high-quality, patient-centered care."

However, the group suggested that ACOs undergo an evaluation before sustaining risk from potential Medicare losses. According to the rules, ACOs would share in Medicare savings and losses. The group said this could harm beneficiaries if ACOs are not ready to assume the risk, and suggested that an assessment at the end of the second year could determine whether an ACO is ready to endure such a risk. Families USA also asked for more representation from beneficiaries on ACO governing boards and improved techniques for notifying patients that they are part of ACOs.

MedPAC Comments

The Medicare Payment Advisory Commission also submitted comments on the proposed rules on Monday.

MedPAC said ACOs could help correct "undesirable incentives" in fee-for-service Medicare that contribute to rising costs.
However, MedPAC suggested that ACOs not be judged by counting how many health care providers participate, because it noted that the groups will take time and money to build.

MedPAC said that in the meantime health care providers might remain attached to the traditional fee-for-service system.
MedPAC also made six general recommendations, including simpler quality reporting for ACOs and clear performance thresholds for each provision in the rules (CQ HealthBeat, 6/6).

AHIP Comments

In addition, America's Health Insurance Plans submitted comments, saying Medicare should use the experience of private insurers as a template for forming ACOs.

According to AHIP, private insurers' experiences would be invaluable because many already have formed partnerships with physicians and hospitals that promote higher care quality and more efficient care.

AHIP also said Medicare should:

• Change its reimbursement scheme;
• Relax existing rules governing the sharing of patient data between doctors and hospitals; and
• Fortify the rules preventing health care providers from shifting higher rates to the private sector (DoBias, National Journal, 6/6).