Top U.S. hospitals, legislators skeptical of proposed ACO rule
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In fact, in a letter dating May 26, Delos M. Cosgrove, MD, CEO and president of Cleveland Clinic, said that while the health system supports the concept of ACOs outlined in the Patient Protection and Affordable Care Act (PPACA), it remains “disappointed” with CMS’ proposed rule.
Cosgrove said that the proposed rule is filled with prescriptive requirements that have little to do with outcomes and detailed governance and reporting requirements that do not focus on outcomes.
Additionally, Cosgrove said that the shared savings structure “creates real uncertainty about whether applicants will be able to achieve success.” Due to these issues, Cosgrove said the proposal will create significant barriers to use and could deter participation.
In addition to Cleveland Clinic, other integral health providers—Billings Clinic in Billings, Mont. and Intermountain Healthcare in Salt Lake City—have also raised concerns. On the heels of the Cleveland Clinic response to the proposal, a gang of seven GOP Senate Finance Committee members denounced ACO regulations saying that incentives and accountability may be misaligned and asked that CMS withdraw the proposed rule.
The senators said that it was “increasingly clear this proposed rule misses the target.”
Because ACOs are meant to realign payment structures to cut costs and improve care, Cleveland Clinic outlined several recommendations that could be rewritten into the proposal to improve the ACO concept.
Some of these recommendations include:
- Dropping CMS’ board composition and relationship requirements that would require ACO participants to hold at least 75 percent control of the board of directors and have patients be involved in ACO governance by having a representative on the board;
- That the CMS establish a framework for appropriate criteria for beneficiary communications and monitor ACO behavior as part of the ACO evaluation process. This would provide accountability regarding beneficiary communications;
- That CMS consider an insurance model where reserves would be required of ACOs to participate, rather than holding back earned savings on the front end with no discussion as to how the holdback might be paid to the ACO;
- Assigning beneficiaries prospectively, with an adjustment period in the initial stages of the three-year period. “Retrospective assignment drastically undercuts the ability of the ACO to manage care efficiently and is counter to the intent of the demonstration project,” the letter stated.
While Cosgrove commended CMS for moving from the Patient Protection and Affordable Care Act (PPACA) to the implementation phase of ACOs, he said he hoped the aforementioned recommendations and others (found here) could be implemented to help improve the proposed rule.
The final rule is expected in 2012, but until then it is back to the drawing board.