AHA: 'Substantial Changes' Needed to ACO Rule

The Centers for Medicare & Medicaid Services must revise its proposed rule for the new accountable care organization program to "restore balance to the risk versus reward equation," AHA said. "[O]ur members have been very excited about the prospect of the ACO program and eagerly anticipated CMS' proposed regulation," AHA states in comments on the proposed rule. However, the association said many members are "disappointed" with the program as proposed and "[s]ubstantial changes are needed to make the program operationally viable and attractive to potential participants."

AHA outlines a series of necessary changes in three areas: shared savings, quality measures and operational flexibility. Among other changes, AHA recommends allowing all ACOs to share in first dollar savings, reducing the number of required quality measures at the outset, and assigning beneficiaries prospectively. "Program success will depend upon the ability of ACOs to manage their patients as effectively as possible," AHA said. "CMS' proposal for patient attribution presents a significant barrier to achieving this goal." AHA is encouraging members to submit their own comments to CMS by the June 6 deadline. In addition, AHA yesterday submitted comments on proposals regarding antitrust issues and the need for additional tax guidance, which were released in conjunction with the proposed ACO rule. Lastly, comments on proposed ACO fraud and abuse waivers are due June 6; AHA has prepared a model comment letter members can use as they develop their response.

06-03-2011 01:54 (EDT)