One of the underreported results of the public comments period for accountable organizations this past summer was the emergence of a gap between patient-centric industry groups and those associations representing care providers of various sizes.
Whereas groups such as the Campaign for Better Care maintained that the NRPM regs "put patients first" and that the ACO model "must be held to standards that ensure they deliver on the promise of better care, better health, and lower cost," organizations operating on behalf of physicians and hospitals insisted that the measure were too burdensome and onerous.
[Reporter's notebook: The biggest surprises in final ACO regs.]
The American Medical Group Association, for instance, published a member survey indicating that 93 percent of respondents would opt not to become an ACO.
Call it a curious divide. Patients who stand to benefit want the bar set high, providers who have to invest and assume some risk to achieve shared savings, also a benefit, prefer that CMS lower the bar.
When CMS unwrapped the final regulations, did it close this chasm?
"Anything that moves the payment and delivery reform ball forward in a sensible and achievable manner is a positive," said Sharon Canner, senior director of advocacy programs at the College of Healthcare Informatics Executives (CHIME). "I think the final rule does close the gap and as with any negotiation, neither side got everything they wanted. Providers get a rule that makes ACOs more tenable, more achievable and the patients get a program that centers on them – a system that shifts provider business models to be more accountable for patient care across settings and time."
Then again, perhaps the patient vs. provider question is "not answerable with regulations," said Bill Bernstein, chairman of the healthcare division at law firm Manatt, Phelps & Phillips, which works with states and providers on health IT and related public policy issues. "We are starting complex new ways of doing business and how they evolve and what they mean for physician and patient, a lot of that is not going to be defined by regulation, even if the regulation has quality measures in it. It will be defined by the character of those organizations and their programs. It's not a regulatory issue, it's an implementation issue."
[See also: Final ACO regs – at first blush, are the changes enough?]
That makes the debate at hand a bit murky indeed – but not the broader and long-term aim of ACOs, which stand to benefit both parties.
"The main promise of the ACO model over time is to turn the very fragmented system into one that is more integrated," said George Roman, senior director of health policy at the American Medical Group Association (AMGA) in this interview with Government Health IT. "And that will produce not only benefits for the Medicare program but I'm hoping for greater care quality delivered and for societal benefits."
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