Medical societies weigh in on easing access to ACOs

Accountable care organizations should eliminate barriers for small practices to partake in this payment model, but any participation by physicians, other health care professionals and patients should be voluntary, according to documents recently issued by several large medical societies.

The establishment of accountable care organizations for Medicare and Medicaid beneficiaries is called for by the recently passed health system reform legislation, and the Centers for Medicare & Medicaid Services is currently writing the rules for these entities. The hope is that ACOs will rein in escalating health care costs, but medical societies have expressed concern that they will accelerate consolidation and squeeze out small practices.

"CMS should adopt policies that facilitate physician-led ACOs and do not inadvertently bias participation in favor of large health systems and hospitals," said American Medical Association President Cecil B. Wilson, MD.

The AMA on Dec. 2 sent a comment letter to the Centers for Medicare & Medicaid Services with its recommendations. They were based on guidance adopted Nov. 9 at its Interim House of Delegates Meeting in San Diego.

Four large primary care medical societies on Nov. 19 released principles on this subject.

The "Joint Principles for Accountable Care Organizations" was released by the American Academy of Family Physicians, the American Osteopathic Assn., the American College of Physicians and the American Academy of Pediatrics (link).

"The [ACP] believes that the current dominant payment system within our health care system -- [fee for service] -- needs to be changed to one that is better aligned to promote improved quality, efficiency and care coordination/integration," wrote Fred Ralston Jr., MD, ACP's president, in an e-mail. "The ACO, at least in theory and from some evidence developed by the CMS Group Practice Demonstration project, may be such an approach. The College and the other primary care organizations support its further exploration."

The "Joint Principles for Accountable Care Organizations" also state that ACOs should be structured to allow for strong leadership by physicians and other health care professionals. Relationships between the various parts of an ACO should be transparent. Incentives should be provided to patients and their families to encourage participation in health and wellness activities, and nationally accepted and validated clinical measures should be used to track performance and efficiency.

The AMA's guidelines are similar.