PPACA: HHS Presses on with ACO Pilot

An ACO is supposed to be a vehicle for helping providers do a better job of working together. The providers that participate in the ACO share responsibility for providing health care for a patient, coordinate the patient’s care, and collect payments that depend at least partly on how well the group has managed the cost of the patient’s care.

The Medicare Shared Savings Program provision in the Patient Protection and Affordable Care Act of 2010 (PPACA) requires CMS to test the ACO concept on enrollees in the traditional Medicare fee-for-service (FFS) program, in an effort to hold down Medicare costs, improve the quality care and see whether the concept might also be useful to Medicaid plans and commercial health plans.

The PPACA provision had broad support, but CMS published an ACO programproposed rule in March that scared off many provider groups, including groups that have been strong supporters of ACO programs, according to health reform analysts at the Deloitte Center for Health Solutions, Washington.

Providers are nervous about the complexity of the proposed regulations, such as a proposal that might subject a pioneering ACO to a battery of 65 quality measures during the first year, the analyst say.

Providers also have questions about whether the CMS ACO savings goals are realistic, the analysts say.

Other ACO coverage from National Underwriter Life & Health:

• CMS Unveils ACO Draft
• PPACA: Health Policy Watcher Questions ACO Concept
• The Year of the ACO
• Humana Forms ACO
• PPACA: Feds Seek ACO, Review Comments