The Catch: Oct. 26

One thing that’s interesting about the earnings current season is that public health insurers and the securities analysts who follow them don’t seem to be obsessing all that much about the effects of the medical loss ratio provisions in the Patient Protection and Affordable Care Act of 2010 (PPACA). The topic comes up during the earnings calls, but not all that much, possibly because the insurers are reporting decent third-quarter results.

CMS ACCOUNTABLE CARE ORGANIZATION RULES

Anesthesia Business Consultants L.L.C., Jackson, Miss., says it likes the revised accountable care organization (ACO) rules that the Centers for Medicare & Medicaid Services (CMS) put out last week.

PPACA requires CMS to experiment with ACOs, which are supposed to be vehicles for shifting traditional Medicare away from the current fee-for-service approach, toward payment mechanisms that encourage groups of doctors and hospitals to work together to manage the care for, and hold down the cost of treating, the whole patient.

Provider groups have generally said that CMS has made a major ACO pilot program cheaper and easier for doctors to participate in; insurer groups say the revised rules could help providers collude to jack up health care prices.

The anesthesiologists’ consulting firm says the final ACO rules should help anesthesiologists and other specialists in some ways but are structured too much around primary care and do not “expressly acknowledge the key role of specialty medical and surgical services,” the firm says.