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Life Health > Long-Term Care Planning

PPACA: Doctors, Consumer Groups Praise New ACO rules

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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.

The CMS Centers for Medicare and Medicaid Innovation will provide some of the payments to participating practices in advance, and that should help the practices handle the high cost of participating in the MSSP, Carmel said.

CMS also made the MSSP friendlier to physicians by taking relatively simple steps such as offering a rolling application process, rather than using one cut-off date, Carmel said.

Federal agencies will be offering ACO providers waivers from federal laws that normally would prohibit prohibits from working together to manage care. CMS is letting ACO providers use the federal law waivers while the providers are planning ACOs as well as after ACOs are up and running, and that should make the planning process more flexible, Carmel said.

Insurers and employers might dislike the antitrust-related changes, but the AMA believes the changes will significantly reduce ACO administrative costs, Carmel said.

The Campaign for Better Care, Washington, an organization that represents Community Catalyst, Boston, and other consumer groups, said it believes the interim final rule will require MSSP ACOs to use “strong, patient-centered” performance criteria and meet strict beneficiary notice and transparency requirements.

“This new rule is not perfect, but it provides a path away from the broken, dysfunctional health care system we have today toward a system that offers higher quality, better coordinated and more patient-centered care,” the campaign said.

The campaign said it has concerns about elimination of provisions in the proposed MSSP regulations that would have required beneficiary participation on MSSP ACO boards.

“We will be watching closely to assess whether ACOs operate in the public interest and reflect the needs and perspectives of the communities they serve,” the campaign said.

But “the stakes are too high to ignore the promise that ACOs offer to improve care and bring us better value for our health care dollars,” the campaign said. “We must not let opponents of reform use any remaining differences to block the progress Americans so urgently need. Transformation is never easy, but the cost of failure to patients, families and the country is simply too high.”

The Campaign for Better Care is backed by The Atlantic Philanthropies, New York.

The Atlantic Philanthropies was founded by Charles Feeney, who created a major duty free shop business.

The Atlantic Philanthropies also has backed Health Care for America Now, Washington, a group that helped win support for passage of PPACA.


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