A six-week comment period on a proposed rule for the creation of accountable care organizations under the federal health reform law ends on Monday, and most of the responses from health care providers are negative, CQ Weekly reports (Kenen, CQ Weekly, 6/6).
Background on ACOs
ACOs, mandated by the federal health reform law, aim to lower costs and improve care by fostering cooperation between physicians, hospitals and other health care providers. The overhaul requires federal health programs to begin contracting with ACOs starting in January 2012.
HHS estimates that ACOs will save Medicare between $510 million and $960 million during the first three years. According to the proposed rule, groups of care providers can qualify as ACOs when they are able to provide primary care for at least 5,000 patients. In order to achieve savings, they also must meet 65 quality standards (California Healthline, 5/24).
Details of Comments
Some organizations have commented that the management of ACOs should be simplified. They said that the rule creates too many bureaucratic and legal hurdles and that the number of quality standards will require excessive data management. Other groups are worried that potential savings are limited, especially when considering startup costs.
Robert Laszewski, a health industry consultant, said, "What you are saying to the provider community is, 'I'm going to give you less money, and you are going to invest millions so you can survive on less money.'" He added, "Why would I be stupid enough to do that?"
Gail Wilensky -- a health policy analyst who headed CMS during President George H.W. Bush's administration -- said, "That so many groups have come out against the ACO regulations ought to be really troubling for an idea that was given so much credence as the driver of reform during the health care legislation debate" (CQ Weekly, 6/6).
Cleveland Clinic Joins Ranks of Providers Criticizing Rule
In a May 26 letter to CMS Administrator Donald Berwick, Cleveland Clinic CEO and President Delos Cosgrove wrote that the organization supports the concept of ACOs but rejects the proposed rule, Fierce Healthcare reports.
Cosgrove wrote that the rule is "replete with prescriptive requirements that have little to do with outcomes, and many detailed governance and reporting requirements that create significant administrative burdens."
He added, "Further, we have concluded that the shared savings component ... is structured in such a way that creates real uncertainty about whether applicants will be able to achieve success" (Cheung, Fierce Healthcare, 6/3).
Berwick Responds to Criticisms
Berwick, responding to the negative feedback, said, "The proposed rule had many, many different things we were trying to adjust and balance," adding, "It's a very important undertaking and we crafted it as carefully as we could."
He pledged to incorporate the comments in designing a better final rule (DoBias, National Journal, 6/3). Federal officials are expected to release the final rule in August (Fierce Healthcare, 6/3).
Consumer Groups Support Rule
A coalition of consumer health groups called the Campaign for Better Care has submitted a comment that states its members support the proposed rule and encourages CMS to maintain more stringent regulations in the face of opposition, CQ HealthBeat reports. The group includes:
- Community Catalyst;
- The Leadership Conference on Civil and Human Rights;
- The National Health Law Program; and
- The National Partnership for Women and Families.
The coalition wrote, "Some are concerned about asking too much of ACOs but we believe these new models must be held to standards that ensure they deliver on the promise of better care, better health and lower cost."
It noted, "If the bar is set too low, ACOs will likely fail -- either by failing to produce real results through a fundamentally difference approach to care or by creating resistance among patients who are called on to pay for or be part of mediocre attempts at change."
The group said it supports a requirement that ACO governing boards include representatives who are Medicare beneficiaries. It also suggested that CMS should require the boards to include representatives from consumer groups (Norman, CQ HealthBeat, 6/3).