Thumbs down

ACO plans draw more crit­i­cism from top ex­ecs

Modern Healthcare - - The Week In Healthcare - Me­lanie Evans

An­other crop of prom­i­nent health­care chief ex­ec­u­tives emerged last week to pub­licly snub Medi­care’s plans for ac­count­able care. Ac­count­able care or­ga­ni­za­tions, one pro­vi­sion to over­haul health fi­nanc­ing un­der the Pa­tient Pro­tec­tion and Affordable Care Act, would of­fer pos­si­ble bonuses or penal­ties to providers based on qual­ity and health spend­ing tar­gets, un­der pro­posed rules.

In a letter to Dr. Don­ald Ber­wick, CMS ad­min­is­tra­tor, more than a dozen CEOs from U.S. hos­pi­tals and health sys­tems echoed other re­cent crit­i­cisms of the draft rules.

Aurora Health Care, which owns a dozen Wis­con­sin hos­pi­tals, won’t ap­ply to test ac­count­able care un­der Medi­care with­out sig­nif­i­cant changes to the pro­posed rules, said the Mil­wau­kee-based sys­tem’s Pres­i­dent and CEO Dr. Nick Turkal, one of 17 ex­ec­u­tives to sign on last week’s letter. “Col­lec­tively and as in­di­vid­u­als, we felt like there were more bar­ri­ers that were put up than there were bar­ri­ers that were taken down,” Turkal said.

The draft rules pay too much at­ten­tion to process, reg­u­la­tory regime and provider risk at the cost of achiev­ing bet­ter care and lower costs, said the ex­ec­u­tives, mem­bers of a coali­tion known as the Academy Ad­vi­sors.

Hos­pi­tals and doc­tors do not know which Medi­care pa­tients will be tied to per­for­mance pay­outs un­til af­ter the fact un­der the pro­posed rule. “Other suc­cess­ful cap­i­ta­tion mod­els are based on both the pa­tient and provider un­der­stand­ing the re­la­tion­ship,” the letter said. Wil­liam Leaver, pres­i­dent and CEO of Iowa Health Sys­tem, who also en­dorsed the letter, said hos­pi­tals can­not mon­i­tor per­for­mance or make needed changes to im­prove with­out timely in­for­ma­tion about pa­tients en­rolled in the ac­count­able care group.

Bonuses pro­posed by the CMS are too dif­fi­cult to achieve, cap­i­tal costs too high and pay­outs too small, the letter said. Of­fi­cials should also con­tinue to work with an­titrust and fraud and abuse en­force­ment to al­low providers to par­tic­i­pate, the letter rec­om­mended, and the CMS should grad­u­ally in­tro­duce qual­ity mea­sures rather than re­quire 65 pro­posed for the first year, which the letter de­scribed as “a sub­stan­tial prac­ti­cal con­straint.”

Not ev­ery­one con­sid­ers the CMS’ pro­posed de­mands too rig­or­ous. Paul Gins­burg, an econ­o­mist and pres­i­dent of the Cen­ter for Study­ing Health Sys­tem Change, in the New Eng­land Jour­nal of Medicine last week, ar­gued the CMS should con­sider its cri­te­ria care­fully be­fore re­spond­ing to crit­i­cism. The de­mand­ing cri­te­ria sig­naled fed­eral of­fi­cials’ de­sire to boost qual­ity and lower costs, Gins­burg said.

“CMS shouldn’t be too quick to lower the ACO bar too far: The ini­tial ACO op­por­tu­nity should not be for ev­ery­body,” he wrote.

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