The American Medical Association says the Obama administration’s main accountable care organization (ACO) test program should work well.
The Centers for Medicare & Medicaid Services (CMS), an arm of the U.S. Department of Health and Human Services (HHS), responded Thursday to health care provider complaints about the original Medicare Shared Savings Program (MSSP) ACO proposal, which was released earlier this year, by streamlining provider participation rules.
New ACOs no longer have to go through a routine antitrust review before they open their doors, ACOs will no longer have to prove that at least 50% of participating providers are making “meaningful use” of electronic health records (EHRs), and participating providers should have an easier time getting paid quickly, CMS officials say.
America’s Health Insurance Plans, Washington, and the American Benefits Council, Washington, have argued that the weaker antitrust rules could give providers a chance to join together to make health care prices higher than they already are.
Dr. Peter Carmel, president of the AMA, Chicago, said the changes CMS made in the MSSP design were important and will help interested physicians participate in the program.
The AMA had recommended that CMS officials encourage participation by physicians in practices of all sizes and should give physicians to share in every dollar of cost savings created by an ACO in the MSSP.
“We are very pleased that this rule allows ACOs to share in every dollar of cost savings and includes an option that limits financial risk, which is important for many physician practices,” Carmel said in a statement.
An ACO is supposed to be a vehicle for paying teams of health care providers to provide and manage care for whole patients, instead of paying for care one service at a time.
The Patient Protection and Affordable Care Act of 2010 (PPACA) requires CMS to try using ACOs and other new approaches to paying doctors and hospitals to get providers to work harder at paying attention to the cost of care, and the ratio of value to cost.
CMS has announced the MSSP ACO pilot project and another pilot project, the Pioneer ACO program.
The final rules released Thursday affect the MSSP, and officials said they would deal with the Pioneer ACO program in future guidance.
Originally, the ACO section of PPACA was viewed as being relatively uncontroversial.
Insurers, health care providers, employers and government officials all agree that the United States needs to find ways to move toward paying for more care on a whole-patient basis, while avoiding the risk management programs that plagued the flat-fee-per-patient capitation programs in the mid-1990s.
But providers were slow to sign up for MSSP while CMS was working on the final MSSP regulations, in part because of concerns about the cost and complexity of participating in the program.