The American Hospital Association has provided its take on accountable care organizations (ACO news) to the Centers for Medicare and Medicaid Services.
In a Nov. 17 letter addressed to deputy CMS Administrator Jonathan D. Blum, AHA Senior Vice President Linda E. Fishman and the hospital lobbying group asked for a wide berth on the issue of ACO implementation, with the goals of having clarity on ACOs and cost savings for healthcare delivery, particularly in Medicare.
"The ACA allows for considerable flexibility in which providers may organize as ACOs. We believe CMS should allow different configurations of provider organizations to enter the shared savings program to see what works and what does not work well," the letter said.
Fishman listed seven "must-haves" and three "must-not-haves" as part of ACO implementation. The must-haves included spending and quality targets by which the ACO's performance must be judged; prospective payment adjustments for such factors as graduate medical education costs; and waivers of what the AHA claims are five major regulatory "barriers" that govern relationships between providers and how incentives are used to change care delivery.
Must-have-nots included rigid organizational/governance rules; dictates on how shared savings are disbursed; and rules on specific services outside of primary care that must be provided by the ACOs.