Everyone’s looking to gain an edge in the upcoming regs governing ACOs
With proposed ACO regulations on the horizon stakeholders angle for favorable provisions
They won’t all get everything they want.
In a raft of recent comment letters sprinkled with recommendations and a few warnings, pretty much any party with a stake in healthcare delivery or an opinion about it has now weighed in on options that face the CMS as it devises regulations for Medicare accountable care organizations.
The CMS is expected to deliver a proposed rule in the first weeks of 2011.
The Patient Protection and Affordable Care Act calls for Medicare to pay bonuses to such organizations beginning in 2012. But the law says little, beyond a basic framework, about how the program would operate.
The letters underscored practical and legal challenges already widely debated among policymakers and organizations hoping to launch such networks.
But the comments—coming from major insurers, health systems, medical device makers, pharmacies, retail clinics, employers, senior advocacy groups, state agencies, associations and medical groups—also highlighted dividing lines among industry players as regulators search for ways to overhaul payment from one of the nation’s largest payers.
The response underscores mounting interest in payment models that might slow the rise healthcare costs as more households are unable to afford care, employers are strained and the federal deficit swells. But some health policy experts caution the accountable care model has yet to be proven, a warning perhaps supported by the letters’ calls for experimentation and sometimes conflicting proposals for how regulators should proceed.
“I would like to see the ability to evaluate, to cancel or to admit we made a mistake if it doesn’t work out,” said Mark Pauly, a health economist and professor at the University of Pennsylvania Wharton School.
As his agency attempts to assemble the nuts and bolts, CMS Administrator Donald Berwick in public remains focused on the bigpicture promise of ACOs and the opportunity for each alliance to go its own way. Much will depend on the resources, providers, history and geography of local communities, he said during a speech last week at the Commonwealth Club in San Francisco.
“I think we are going to see a rebirth of organizations able to make care a journey and not a fragmentation,” Berwick said. “Organizations that will have memories about patients, not amnesia.”
And as he has before, Berwick warned there will be two camps in response to the changes under the reform law. One will be “authentic, they will be the real partners on a great national expedition.” The others, he said, will use the new terms, such as ACOs, but “they will become cloaks of the status quo.”
More good than harm?
Some of the commenters argued that hospitals and doctors in accountable care groups should be at risk to lose money as well as earn bonuses for quality and savings achieved, as proposed in the law. Yet others said they feared such a mechanism could burden providers with financial risks akin to insurers,
CMS Administrator Donald Berwick says the success of ACOs will depend on a variery of factors, including community resources.