Feature: AMA president parses out pros, cons of ACO rule
 | |
| Peter W. Carmel, MD, president of the American Medical Association (AMA) |
What was your initial reaction to the final rule?
We are very pleased that the final rule includes a significant number of the important changes recommended by the AMA. [For example,] we asked CMS to make Medicare ACOs more accessible for physicians, and CMS listened. After reviewing the proposed rule earlier this year, the AMA made numerous suggestions to CMS on changes needed to ensure physicians in all practice settings could lead and participate in ACOs.
What is the implication for healthcare providers now having an option that limits financial risk? Do you think this helps ACO adoption?
This is critically important, especially for physicians in small practices. The AMA asked for this change because it makes it easier for physicians to envision their practice as part of an ACO.
Because starting an ACO could be costly to implement, what requirements will help ACO adoption going forward and how do you think that adoption will affect the healthcare system?
Many physician-focused improvements were made to this rule, and taken as a whole they will make it easier for physicians to lead and participate in this new model of care. It is important that physicians now have much greater flexibility overall–especially related to available risk and payment structures. We are very pleased that the final rule allows ACOs to share in every dollar of cost savings and includes an option with limited financial risk. As the cost of forming an ACO is high, physician practices will also benefit from the new advanced payment initiative created through the Center for Medicare and Medicaid Innovation that is tasked with providing financial assistance for physician-owned organizations.
Do you believe that CMS' decision to limit its savings split with providers to 50 to 60 percent will limit participation in the program? Why or why not?
No. This is a shared savings initiative, where physicians, patients and the Medicare program all benefit when high quality, cost-effective care is provided. CMS and ACOs will share in achieved savings, but there is no limit on the amount of savings a provider within an ACO can receive. The new rule actually increases the amount of savings physicians can achieve by allowing them to share in the savings beginning with the first dollar.
What specific flexibility would AMA have preferred on which measures practices are required to report? How do you feel the final measures will affect participation?
The AMA is still reviewing the final rule, including the specific quality measures ACOs will be required to report. We are pleased that the rule cuts the number of required measures in half, but the AMA would have preferred even greater flexibility for ACOs to choose the most applicable measures on which to report.
Do you have any opinions on the requirement on allowing beneficiaries to participate in the ACO, but also opt out of sharing data? What implications do you think this might have for providers?
It is critical for patients in an ACO to play an active, engaged role in their care. The AMA would have preferred for patients to self-select an ACO and share their information. It will be important for CMS to provide information for patients to help them understand the benefit of participating fully in ACOs.
As AMA reviews the bill, how are you hoping that the ACO rule will affect the care system at large?
The AMA has stressed throughout this rule-making process that, if implemented in a way that allows physicians to lead and participate, the Medicare ACO model offers promise to improve care coordination and quality while reducing costs. This benefits patients, physicians, taxpayers and the Medicare system as a whole. The final rule gives interested physicians the flexibility needed to lead and participate in this new model, where they can share in the savings that are achieved through the quality, coordinated care they provide to patients.