Legal pitfalls of ACOs (Pt. 2)

The payoff

FH: What is the patient reaction to ACOs?

MG: Patients don't want to be assigned. They want to maintain patient choice. It's really a conundrum; I'm not sure how [CMS is] going to fix it. If you maintain patient choice and the patient leaves, what are [providers] going to do? It's going to be interesting to see if organizations drop below that 5,000 [patient eligibility requirement].

FH: Which institutions benefit from the proposed savings?

MG: This is really targeted to large organizations. The savings really come if you have higher numbers of beneficiaries.

FH: And smaller organizations would not benefit as much from ACOs?

MG: They've got a lot of work for not a lot of payoff.

FH: Some organizations, including the American Hospital Association, have been urging CMS to clarify the fraud and abuse waivers, as to not prevent care coordination efforts. What are the challenges with issuing these waivers?

MG: [The government] is going to put in waivers of certain laws but for only certain time periods. There's start-up time so you may have to give people money to join the program because they are going to have costs. That's why a highly integrated group will do better than a bunch of smaller practices. In theory, this could work, but the problem is you only have a narrow band of waivers, it might not make it worthwhile.