Roundup: ACO Proposed Rules Fuel Uncertainty

John Commins, for HealthLeaders Media , April 8, 2011

"I read carefully the discussion of antitrust safety zones, how primary service areas are defined, the 30% threshold," he said. "The language in the guidance suggests that they have been very thoughtful about waivers and antitrust. And, they have maybe been cautious thinking about what will happen if commercial health plans piggyback the ACOs and use them as their contracting organizations. Does that consolidate power? Does it create cartels? I was impressed by the granularity of the language in that section."

Keckley said the overarching theme from the government is the emphasis on physician-hospital alignment. “You have value-based purchasing, and episode-based payments and avoidable readmissions, and the medical home, the ACO, physician quality reporting initiative and the physician self-referral language and you step back and see they are compelled by the vision of integrated systems," he says. "That to me is the big cake here."

And, like any sweeping government program, ACOs come with their own language. Soon, healthcare wonks and consultants who last week couldn’t tell a “Safety Zone” from a “Primary Service Area” will be tossing out eye-crossers like “Precompetitive,” “Retrospective Assignment,” “Dominant Provider Limitation,” and “Group Practice Reporting Option” (which will undoubtedly morph into the catchy GPRO) in dozens of forums, webcasts, seminars, and retreats from coast to coast. That’s the first thing you do when you’re in a new culture -- you learn the language.

One thing is clear—technology will play a huge role. "Clearly, health IT is the backbone, the enabler to an ACO," says Warren Skea, PhD, director, health industries advisory practice at PricewaterhouseCoopers, which sponsored HealthLeaders Media's Breakthrough's report, The Bridge to Accountable Care Organizations.

Welcome to the new world of ACOs.

John Commins is a senior editor with HealthLeaders Media.

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