ACO Regulations Will Cause Headaches for Doctors
The requirements contained within the 492 page volume of regulations, which will govern Accountable Care Organizations (ACO’s), will create ‘significant barriers’ that will discourage the support of the concept of ACO’s. So says Delos Cosgrove, the CEO of the Cleveland Clinic, in an eight page letter to Donald Berwick, top administrator for the Center for Medicare and Medicaid Services (CMS). In his letter, posted by Modern Healthcare, Cosgrove claimed: “Rather than providing a broad framework that focuses on results as the key criteria for success, the proposed rules are replete with 1) prescriptive requirements that have little to do with outcomes, and 2) many detailed governance and reporting requirements that create significant administrative burdens,”
To be considered an ACO, an organization would agree to manage all of the health needs of a minimum of 5,000 Medicare beneficiaries for at least three years, in accordance with proposed federal guidelines. The concept of ACO’s should be appealing to hospitals because ACO’s that save Medicare money will be eligible to share in some of that savings themselves. However, the regulations may make it impossible for hospitals to adhere to the guidelines, provide improved healthcare, and save money.
ACO’s are very similar to the HMO’s of the 1990’s, but with onerous government regulations controlling them. The only way that HMO’s saved money was by restricting healthcare for their members. The only way that ACO’s will be able to save money is to drastically cut healthcare for their participants, because they will have to demonstrate compliance with all the regulations required by the CMS, costing them significantly in compliance overhead.
To the individual doctor in private practice, or a small group practice, compliance with the ACO regulations may make it cost ineffective to join an ACO. It makes no sense to join an ACO if you will not increase your income, while exposing yourself to disciplinary action (including fines) from the CMS for not complying with the 492 page regulation book.
I don’t like being put into a situation where I have less control over my practice or patient’s healthcare, and neither should you. Most practicing healthcare providers don’t have the time to read the proposed regulations from the CMS, so they won’t be able to submit proposed changes to the CMS during its current public comment period. People like Dr. Cosgrove, who have the responsibility to be aware of any regulations which may affect his organization, will be able to read the proposed regulations and make suggestions on how to improve them to benefit his organization. Other hospitals have also written to Dr. Berwick, complaining about the excessive regulations and too little financial incentive. When the hospital CEO’s submit their ideas for improvement to the proposed rules governing ACO’s, they will have the interests of their employees and shareholders foremost in their minds. The individual doctors may also benefit, but they will not be the highest priority for the hospital CEO’s. Once again the individual healthcare provider will be most likely to bear the brunt of any deleterious changes in the healthcare field.
While I am trying to keep these posting fairly apolitical, it is interesting to note that the Cleveland Clinic is a well known organization that has been lauded by the Obama administration. It will be interesting to see what, if any, changes will be made in the ACO regulations as result of the public input from healthcare providers.
You also need to realize that the ultimate goal of the Patient Protection and Affordable Care Act (PPACA) is to force Americans into a single payer system run by the government. That is one reason that the rules governing ACO’s are so onerous, so that they will not work and healthcare costs will go up, or access to healthcare is restricted. Then when the American public complains about the lack of quality healthcare at an affordable price, the government will be able to claim that the private healthcare delivery system does not work, and the government has to intercede and take over the delivery of healthcare.
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Thursday, 16 June 2011
posted by Satinder Ajrawat MD
Interesting article. Not good for the physicians as usual. Unfortunately as long as one is dependent upon someone else for their re-imbursement, they will continue to push. Managed care in the 90's and now ACO's.
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