Despite predictions that accountable care organization regulations will be released this week, an "imminent budget battle" and possible government shutdown could create a political climate too tense to unveil them, National Journal Daily reports.
Background
ACOs are intended to help hospitals and other providers coordinate and provide effective care. The regulations would determine how ACOs qualify for CMS' shared savings program in 2012 (McCarthy, National Journal Daily, 2/25).
On Thursday, CMS Administrator Donald Berwick said that CMS will "imminently" issue the proposed ACO rules (Gillespie, Health Data Management, 2/24).
However, the regulations have been stalled in the Office of Management and Budget, National Journal Daily reports.
Regulations Remain Controversial Among Major Health Lobbies
Meanwhile, hospitals, physicians and insurance companies remain at odds over the anticipated regulations, as each group vies to ensure different rules.
The lobbies' largest concerns involve competition and whether ACOs will be excluded from fraud and antitrust laws.
However, hospitals and physicians agree that ACOs need "safe harbor" from antitrust laws for privately insured patients, noting that pricing flexibility is necessary for all patient populations because it would be "cost-prohibitive" to serve only Medicare beneficiaries.
Both groups also want the government to waive fraud laws for physician kickbacks for all ACOs, rather than providing waivers on an individual basis.
Control of ACOs
According to National Journal Daily, hospitals and physicians are competing for ultimate control of ACOs.
For example, many hospitals currently are spearheading efforts to merge with physician practices, while the American Medical Association wants physicians to sit on ACO governing boards to mitigate the role of commercial interests in medical decisions.
HHS Secretary Kathleen Sebelius has said the department does not "see a hospital-dominated model being the only strategy, "noting that community health centers also have merged with physician groups to form ACOs (National Journal Daily, 2/25).