Internal CMS schism slows ACO payment rule development

CMS Administrator Donald Berwick has promised that accountable care organization draft regulations will be out in December. But CMS staff are still wrestling over which ACO payment approaches to endorse, ACO Business News reports.

An internal rift apparently is complicating matters. Because the ACO program was designed to operate within Medicare Parts A and B, the agency has assigned regulatory development to staff that are A and B experts, a former senior federal official told ABN.

Strangely enough, CMS's managed care staff, who have been exposed to managed care concepts, are not involved in developing the ACO regulations. The CMS career staff who are in charge have an anti-managed care bias, the former official said, and are leery about partial capitation.

Although many groups may be interested in becoming part of an ACO if the Medicare program goes with a partial-capitation payment model, CMS doesn't have experience with that approach, John Gorman, CEO of Washington, D.C.-based Gorman Health Group, told ABN, because it's a fee-for-service agency.

Gorman said the White House and HHS secretary's office's open hostility to managed care plans is also gumming up the process. Still, he remained optimistic. If CMS leaves the ACO regulations flexible, "it will show Berwick and [CMS deputy administrator Jon] Blum's cooler heads prevailed," he said.

To learn more:
- here's the ACO Business News story

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