Nearly two-thirds of respondents to a recent survey say they
have already taken steps or plan to take action to prepare for
participation in Accountable Care Organizations, the joint ventures
established by the healthcare reform legislation in which doctors,
hospitals and other providers coordinate patient care. Survey
respondents, however, also identified serious obstacles to ACO
participation such as access to capital and physician shortages.
The ACO survey, conducted on behalf of the law firm Waller Lansden
Dortch & Davis, LLP by Modern Healthcare's Custom
Research team, explored the challenges ahead for ACO participants
including identifying costs of creating and operating an ACO and
funding strategies.
The survey highlighted the critical role of hospital-physician
alignment. Nearly two-thirds of respondents cited increased
alignment with primary care physicians as a step taken in
preparation for ACO participation, and three out of five
respondents cited alignment with physicians through employment.
With respect to obstacles to ACO participation, the lack of a
sufficient number of primary care physicians and specialists ranked
second and third among "very serious obstacles" to
participation behind only access to capital. More information on
the Waller Lansden ACO survey is available at
www.wallerlaw.com/ACOSurvey.
Underscoring the concerns of the Waller Lansden survey respondents,
CMS last week received highly publicized objections to the ACO
regulations proposed in March. The American Medical Group Association
called the Proposed Rule "overly prescriptive, operationally
burdensome," and stated that "the incentives are too
difficult to achieve to make this voluntary program
attractive" and that 93% of its members would not participate
under the proposed rules. The following day, CMS Administrator
Donald Berwick received a letter from the ten multi-specialty
groups that participated in the Physician Group Practice (PGP)
Demonstration Program which cited "serious reservations about
the economics and the complexity of the Medicare Shared Savings
Program/ACO NPRM."
While not directly responding to these and other concerns over the
proposed ACO regulations, on May 18th, the Department of Health and
Human Services announced three new initiatives to encourage
providers to participate in ACOs. The Pioneer ACO Model
will be available this summer for providers that already coordinate
patient care across care settings. CMS stated that the new model
will enable "these provider groups to move more rapidly from a
shared savings payment model to a population-based payment model on
a track consistent with, but separate from, the Medicare Shared
Savings Program." The Center for Medicare and Medicaid
Innovation is to release a request for applications for this
program. CMS announced that it is requesting input on an
Advance Payment ACO Initiative that would allow
"certain ACOs participating in the Medicare Shared Savings
Program access to a portion of their shared savings up front"
to provide assistance with funding the start-up of the ACO. CMS
also announced Accelerated Development Learning Sessions,
education programs offered at no cost to "help providers learn
what steps they can take to improve care delivery and how to
develop an action plan for moving toward better-coordinated
care."
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