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Life Health > Health Insurance > Your Practice

PPACA: Agencies to Address Antitrust Barriers

By Allison Bell

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The Federal Trade Commission (FTC) will be joining with federal health agencies Oct. 5 to host a workshop on “accountable care organizations” (ACOs).

An ACO is a provider group that takes responsibility for the cost and quality of care given to a designated group of patients.

An ACO could be a multispecialty group practice, which might or might not be a high-tech, high-touch “medical home”; a multispecialty group practice linked to a hospital; or an association of independent health care providers.

The Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act (PPACA), has a provision that will make the ACO model an official part of the Medicare program starting in 2012.

The providers in a Medicare ACO can split the financial gains resulting from improvements in the quality and cost of the care they provide.

Medicare already has tried ACO pilots, and private carriers also have been experimenting with ACO programs.

In the past, the U.S. Department of Justice and the Federal Trade Commission have successfully argued in court that efforts by providers that are not part of the same health care organization to set the fees charged insurers or other payers

are restraint-of-trade violations of the Sherman Antitrust Act.

Officials from the FTC, the Centers for Medicare & Medicaid Services (CMS), and the U.S. Department of Health and Human Services (HHS) inspector general’s office will appear at the October ACO workshop to get public comments on the legal issues raised by proposed ACO models, FTC officials say.

“Physicians, physician associations, hospitals, health systems, payers, consumers, and other interested parties are invited to participate in the workshop,” officials say in an ACO workshop notice

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