WASHINGTON – The proposed regulations for accountable care organizations released March 31 by the Department of Health and Human Services represent one of the first delivery-reform initiatives to be implemented under the Affordable Care Act.
Donald Berwick, MD, administrator of the Centers for Medicare and Medicaid Services, said ACOs are key to healthcare reform, and their purpose will be to "accelerate progress" toward better healthcare for individuals and populations and to slow growth in healthcare costs.
Under the proposal, ACOs would create incentives for healthcare providers to work together to treat an individual patient across care settings. The regulation does not specify how much incentives providers would earn participating in the voluntary program, and Medicare Advantage plans would not be included.
To share in savings, Medicare providers participating in ACOs would have to meet quality standards in patient care experiences, care coordination, patient safety, preventive health and at-risk population health.
The proposed rules include "strong protections to ensure patients do not have their care choices limited by an ACO," according to HHS Secretary Kathleen Sebelius.
The rule calls for a start date of Jan. 1, 2012. The program is expected to save $960 million over three years for the Medicare program, Sebelius said.
HHS is accepting comments on the rule through June 6. Before the rule is finalized, CMS will review all comments and may make changes to its proposals based on the comments, Sebelius said.
William F. Jessee, MD, president and CEO of the Medical Group Management Association, gave the proposal an initial mixed review.
"The formation of ACOs has the potential to greatly improve the coordination of care received by Medicare beneficiaries and offers the promise of safer, more efficient and effective care," Jessee said.
However, he told doctors to exercise caution before participating.
"The complexity of the program as proposed is significant," he said. "With multiple agencies proposing rules on the same topic, physician practices need to thoroughly examine how participation in ACOs may affect their practice operations."
Hospitals belonging to the Premier healthcare alliance showed support. Blair Childs, senior vice president of public affairs for Premier, said ACOs represent "one of our best hopes for overcoming fragmentation in care delivery."
"Premier believes it is critical that government regulations do everything possible to remove impediments that could derail ACO development, as well as select ACOs and structure the program to maximize the potential for success," Childs said. "We are extremely pleased that CMS will allow multiple payment models within the ACO program from the start."
Jeff Gruen, director of healthcare services at PRTM, a global management consulting firm, predicted CMS will keep the program small at first.
"CMS is caught in a vicious dilemma: They need to keep momentum for the ACO program to convince providers to invest in ACOs for the long term," he said. "If the program is too restrictive early on, interest in ACOs could lose steam."