Health Reform Update from National Business Coalition on Health
As
NBCH and many organizations are preparing to submit comments to HHS on the ACO
federal regulations, the nation’s highest-profile health care centers — the
Cleveland Clinic, the Mayo Clinic, Intermountain Healthcare or the Geisinger
Health System —have so many concerns with the proposed rule to create ACOs that
they doubt that they will participate.
The 2010 health care
law (PL 111-148, PL 111-152) created the authority to establish
ACOs — networks of providers within the Medicare system that include
physicians, hospitals and health systems. The aim of the integrated networks is
not only to improve the quality of care but also to save money, with any
savings to be shared by the government and the ACOs. The Centers for Medicare
and Medicaid Services (CMS) released a proposed rule at the end of March that
spells out the details of how the program will work, how much financial risk
medical providers will face, and what type of data the organization need to
collect.
Interviews with
officials at integrated care organizations yield a similar reaction to the
proposal: The idea behind the Medicare rule is a good one. But there have to be
major changes to the details before the program would be workable. Even the
most sophisticated health care systems in the nation, which have already
adopted a number of the practices that Medicare officials want providers to
carry out, say there isn’t enough incentive for them to apply to become an ACO
under the Medicare proposal.
But the fact that the
even the institutions that were the inspiration for the program are reluctant
to participate unless big changes are made shows that CMS officials face a
tough task. Officials who are weighing changes to the proposal before they
finalize it later this year will have to consider how far they want to go to
attract interest. The complaints against the proposed rule are many and
multi-faceted.
One basic issue is
that all institutions who sign up will face a financial risk if they do not
generate savings required by the rule. The proposal suggests a two-track
system. Providers could choose to get a bigger financial reward if they subject
themselves to penalties starting in the first year. Or they could have the
potential of a less generous reward if they choose to wait until the third year
of the program to face penalties. Many providers had expected the program to
offer a way for institutions to get bonuses without having to face penalties
and were disappointed that the rule proposes a potential financial hit for any
group that doesn’t find required savings.
Because of all of the
concerns, many of the nation’s top integrated care institutions are concluding
that the start date of Jan. 1, 2012 needs to be delayed. Health center
officials say it will be hard to review the requirements in a final rule, which
isn’t expected to be released before late summer at the earliest, meet
financial requirements, set up quality metrics and enroll by Jan. 1. (Source:
CQ HealthBeat, May 6, 2011)
Read Forbes Magazine article outlining major concerns.