ACO rule: Healthcare industry reacts with cautious enthusiasm

The Centers for Medicare and Medicaid Services released its long-awaited proposed rules on accountable care organizations yesterday. Although they officially have until June 6 to file comments on the rules, a variety of healthcare industry voices wasted little time in chiming in on what the 429-page document means.

"An ACO will be rewarded for providing better care and investing in the health and lives of patients," said CMS Administrator Donald M. Berwick. "ACOs are not just a new way to pay for care but a new model for the organization and delivery of care."

The Medical Group Management Association, the primary lobby for physician groups, veered between enthusiasm and caution. "The formation of ACOs has the potential to greatly improve the coordination of care received by Medicare beneficiaries, and offers the promise of safer, more efficient and effective care," said MGMA CEO William F. Jessee in a statement. "The complexity of the program as proposed is significant. With multiple agencies proposing rules on the same topic, physician practices need to thoroughly examine how participation in ACOs mayaffect their practice operations."

The American Medical Association, the primary physician lobby, struck a similar tone. "ACOs offer great promise for improving care coordination and quality while reducing cost, but only if all physicians who wish to are able to lead and participate in them," said Jeremy A. Lazarus, speaker of the AMA House of Delegates. "For this to happen, significant barriers must be addressed, including the large capital requirements to fund an ACO and to make required changes to an individual physician's practice, existing antitrust rules and conflicting federal policies."

Voices on the payer side were more blunt. Karen Ignani, CEO of America's Health Insurance Plans, said ACOs presented "an opportunity for Medicare and Medicaid to build on the successes of the innovative payment systems that exist in the private marketplace today to improve the quality and safety of patient care and help put the health care system on a sustainable path."

However, she also cautioned that ACOs "could accelerate the trend of provider consolidation that drives up medical prices and result in additional cost-shifting to families and employers with private coverage. However, we appreciate that CMS, the Department of Justice, and the Federal Trade Commission recognize the potential for consumer harm and are taking steps to address this issue with proposed guidelines for evaluating ACOs and their potential impact on consolidation within the marketplace."

For more:
- read the American Medical News article
- here's the MGMA statement
- read the AHIP statement

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