Organized medicine, others give CMS feedback on ACO regulations

The Centers for Medicare & Medicaid Services received 417 comments from medical societies, physicians, large health systems and others in the health care industry in response to a request for comment about accountable care organizations.

The agency, which issued its request Nov. 17, 2010, wanted feedback on the kind of policies that would ensure that small and solo physician practices would be able to participate in the Medicare Shared Savings Program and accountable care organizations called for in the Patient Protection and Affordable Care Act.

"The response shows significant interest in how ACOs will be structured, and we are taking the comments very seriously as we develop our proposed rule," said CMS spokeswoman Ellen B. Griffith.

Other questions asked by CMS: How should patients be attributed, and how should their experience, along with that of their caregivers, be assessed? What aspects of patient-centeredness are important? What quality measures should be used? What other payment models should be considered?

The deadline was Dec. 3, 2010, and numerous medical societies sent input, because concern is high that the legislation and various economic pressures are making small, independent medical practices economically unviable.

The American Medical Association called for safe harbors from antitrust enforcement and waivers of the civil monetary penalty statute, the anti-kickback statute and Stark laws so that small, independent practices can work together and with hospitals without necessarily being directly employed by a large institution. The minimum number of Medicare beneficiaries should not be increased beyond the 5,000 mandated by health system reform, and expensive electronic medical records should not be required, according to the AMA.

The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Assn. sent CMS its "Joint Principles for Accountable Care Organizations" issued Nov. 19, 2010. The organizations also weighed in individually.

For example, AAP's comments advocated that smaller primary care practices receive a larger proportion of first-dollar savings than other participants in an ACO, and that hospitals receive incentives for "optimizing" admissions. The AAP wants small practices to receive incentives for hitting quality benchmarks for the first few years of the program. Payments for cost savings should be instituted further down the line.

A draft of the rules and regulations for the Medicare Shared Savings Program is expected in mid-January. The agency will take comments before the rules are finalized.