When accountable care organizations (ACOs) take on jobs that health plans have been handling, they should meet the same standards that health plans have to meet, according to America’s Health Insurance Plans (AHIP).
AHIP, Washington, and many other trade groups, professional societies, individuals and others have been responding to an ACO proposed rule released by the Centers for Medicare and Medicaid Services (CMS), an arm of the U.S. Department of Health and Human Services (HHS), in May.
CMS is implementing Section 30222 of the Patient Protection and Affordable Care Act of 2010 (PPACA), which requires Medicare to test whether the ACO concept or other new care delivery and provider reimbursement strategies can help hold down Medicare costs while improving the quality of care.
CMS has proposed setting up a Medicare Shared Savings Program (MSSP) that would require hospitals, doctors and other providers to meet strict requirements when joining to form ACOs.
Any private insurers participating in an ACO also would have to meet strict requirements, such as a 25% cap on health insurer representation on an ACO’s governing body.
Providers have argued that the CMS MSSP rules are intimidating even for the large, well-funded, researcher-staffed group practices that have promoted the ACO concept.
The American Medical Association (AMA), Chicago, has submitted a comment calling for CMS to assign Medicare patients to ACOs based voluntary agreements, let physicians know which patients are in the ACO, and ease up on electronic health record use requirements.
The proposed rule would require a high percentage of primary care doctors in an ACO to be using electronic health records by the second year.
The AMA also is asking CMS to reduce the number of quality measures and reporting requirements ACO member health care providers would have to meet, and focus the quality requirements on the measures most relevant to a provider’s patient population.
Carmella Bocchino, an executive vice president at AHIP, and Joni Hong, a senior counsel at AHIP, say ACOs that are acting like health plans ought to be carefully regulated.
AHIP member companies have been meeting state insurance department financial requirements and