The American Medical Association is calling on the Federal Trade Commission and Department of Justice to make changes to their proposed policy regarding antitrust enforcement of accountable care organizations so that physicians in all practice sizes can develop, lead and actively participate in ACOs.
“The FTC and DOJ antitrust policy is a critical piece of the proposed rules governing ACOs, and it must lay the groundwork for the success of these new models of care,” said AMA President Cecil B. Wilson, MD. “Forming an ACO requires significant resources for physicians and may include major changes to their practice. If physicians cannot see a clear path to forming an ACO, these models will not achieve their full potential to increase care coordination and promote cost savings.”
[See also: ACOs key to healthcare overhaul, Berwick says.]
The AMA has stated that existing antitrust rules can make it difficult for physicians, especially those in small practices, to participate in an ACO. A full 78 percent of office-based physicians in the United States work in practices with nine physicians or less, and a majority of those are in practices of one to four physicians.
Under existing antitrust enforcement policies, these physician practices are effectively prohibited from jointly contracting with private payers around necessary care improvement and coordination efforts.
“While we appreciate this first step in proposing necessary changes to antitrust rules, further clarification and modifications are necessary to ensure physicians in all practice sizes can form an ACO,” said Wilson. “As proposed, the FTC and DOJ policy on ACOs simply does not go far enough to level the playing field, leaving small physician practices at a disadvantage compared to hospitals and dominant insurance companies.”
[See also: AMA details onerous regulatory burdens on doctors.]
The AMA voiced support for the goals of proposed policies including the rule of reason analysis, the establishment of a safety zone and a 90-day expedited review process for ACOs that require an FTC/DOJ approval, but prescribed specific modifications to allow all physicians who wish to do so to successfully form ACOs, including raising the safety zone threshold from 30 percent to 40 percent and the mandatory review threshold from 50 percent to 60 percent. The AMA also recommends permitting ACOs to exceed these thresholds if they face competition in their markets.
The AMA will also submit comments to the Centers for Medicare and Medicaid Services regarding its proposed rule governing ACOs. Read the comments to the FTC and DOJ here.