ACO Rules “Impenetrable”

Merrill Goozner

First published 4/19/11 at Gooz News

Michael Millenson, a health care consultant who many moons ago worked as I did at the Chicago Tribune, has offered a scathing critique of the Center for Medicare and Medicaid Services’ proposed rules for setting up accountable care organizations (ACOs), which are health care reform’s primary delivery system reform. Says Millenson on the Health Care Blog:

The central problem with the draft regs is that the risk-reward ratio is highly skewed. The Centers for Medicare & Medicaid Services painstakingly delineates a dizzying litany of hurdles to surmount, from documenting progress on 65 different quality measures to Medicare editing your marketing materials and to government monitors descending upon your offices. Meanwhile, the promised rewards are wrapped in a fuzzy package of impenetrable risk-adjustment algorithms and wait-till-next year financial commitments that sound like a cross between a cell-phone contract and a time-share vacation offer.

It will be interesting to review the comments from the providers as they come in. For reform to work, ACOs will have to save money for Medicare. Otherwise, rigid caps proposed by the Independent Payments Advisory Board will go into effect, assuming, of course, that Congress votes in favor or for comparable cuts. If Millenson is right, the scramble to set up ACOs currently underway at major hospital networks will fizzle. The IPAB will become a major player. And the war over cost control will be fought — and lost — where it has always been fought and lost: On Capitol Hill, where the lobbyists for the physician guilds and health care provider industries hold sway.

Merrill Goozner is an independent health care journalist who also maintains a blog at Gooz News.

This entry was posted in Analytics, Benefits, Market Dynamics, Medical Management, Physicians, Policy/Law/Regulation, Quality and tagged , , , , , , , . Bookmark the permalink.

One Response to ACO Rules “Impenetrable”

  1. Andy Behrman says:

    As the representative for the federally qualified health centers (FQHCs) I can tell you our comments won’t be happily received. These regs are confusing and convoluted and that’s the least offensive I could be.

    FQHCs aren’t even able to form an ACO and the rationale for this? A billing code complexity? Are you kidding me? CMS can’t figure out how to allow us to bill? I wonder where this comes from. We’ve done a very detailed review (as have many) and found that it seems to be unlikely that it will meet its intended goals, more likely to reach it’s unintended demise.

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