Physicians stress flexibility with ACO models

How should accountable care organization be structured?

If public comments submitted to CMS are any indication, physicians groups have been worried enough to urge the administration to stay flexible on organizational models that might serve for such organizations.

In a letter the American Medical Association sent to CMS, it called on the administration to "do everything possible to facilitate participation by all types of provider structures authorized under the Affordable Care Act, and not inadvertently bias participation in favor of large health systems and hospital-dominated networks." ACOs may include group practice arrangements and networks of individual practices of physicians, per the healthcare reform law.

In similar vein, in a letter to CMS, Ralph Brindis, president of the American College of Cardiology, warned that in the integrated health system model, or a model built around a hospital, "all of the power in the relationship is handed to the hospital or institution within the system, simply by virtue of its consolidated nature, as opposed to the disparate and diverse interests of individual private practices."

He urged CMS to encourage the involvement of private practices in ACOs without implicitly encouraging mergers and the creation of consolidated health systems with substantial market power. "Regulations should be crafted in such a way that private practices are protected in these arrangements," he wrote. Private practices are smaller, and thus, generally able to be more nimble than large institutions when it comes to making changes to the way business is conducted and care is provided.

In a letter from America's Health Insurance Plans, the general counsel also urges CMS to consider a range of ACO models, beyond large integrated health systems, such as smaller physician groups and not surprisingly, models that are formed by, or in partnership with, health plans. AHIP includes three examples of ACOs that involve collaboration with health plans.

To learn more:
- read the public comments posted on the Federal Trade Commission's website

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