AMGA Raises Red Flag on 'Burdensome' ACO Rules

John Commins, for HealthLeaders Media , May 13, 2011

In an interview Thursday with HealthLeaders Media, Fisher said AMGA would provide a detailed critique of the proposed rules and a list of recommendations before the end of the public comment period on June 6. "We just sent this letter because we wanted to make sure that CMS was aware of the significant changes that need to be made, and let them know how serious these problems are. We didn't want to wait until the process had already started," he said.

Fisher detailed a list of concerns that AMGA would address in its formal comments.

Risk Adjustment: "We're concerned that CMS intends on adjusting the risks on ACOs costs calculations only for the first year, and these are three year agreements. Most of my members are very worried that they are going to get adversely selected against by frail and ill patients because the word will get out that these are high quality low cost organizations that do a terrific job taking care of patients. If you don't adjust after the first year and get an influx of patients that are much more severely ill than the first estimates gives, you are going to be risk adjusted incorrectly."

ACO Patient Attribution: "The attribution model that CMS is proposing is retrospective. They are going to do a look-back over three years to count the plurality of primary care visits to a facility. Whoever has the most gets that patient. They aren't going to have that until after the first year. So you are going to have to gear up to be an ACO, you are going to have to make an investment in the infrastructure, and you are not going to know who your patients are until after that first year. And, given that there is a 5,000 Medicare beneficiary minimum by statute, you might do all of these investments and find out you don't hit the 5,000 Medicare beneficiary threshold and you are out of the program. We would like to see them do a prospective patient attribution. Let's have these ACOs know who their patients are when they begin so they can make sure those patients are getting the care they need to improve quality and lower costs."

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1 comments on "AMGA Raises Red Flag on 'Burdensome' ACO Rules"

Daniel Connelly (5/13/2011 at 8:59 AM)
ACOs are an Obama supported initiative, first started as a concept in 2006. They are basically a rehash of the PPO with a few twists. The ACOs are promoted by Physicians for a National Health Program (PNHP) whose activist list in NJ is the unions. PNHP wants the bill HR676 passed to put everyone on medicare. Why would PNHP, the unions, and Obama liberals promote ACOs, when they really want medicare for everyone? ACOs are designed specifically to fail as an intermediate step to full government run socialized medicine. The following is the brief on how this would happen and I believe that it would happen quickly. 1. Hard working physicians are dazzled with the promises of the ACO. Collaborative, integrated accountable care will decrease overhead, improve care and decrease the work load of physicians. That's the bait. 2. Down play the transfer of "risk" from the insurance companies, the union plans, and the government to the ACO. That's the trap. 3. The ACO becomes the defacto insurance company with all attendant risks, no multimillion dollar reserve or the ability to print money. 4. The physician is torn being the patient advocate and the insurer delayer/denier of claims. Deny a claim (demand for service) and get sued. Be the patient advocate and don't deny claims, the ACO becomes insolvent, bankrupt, financially unviable. 5. The federal government steps in to save the failing ACOs and incorporates them into the national system, along with all the business assets 6. With most of the medical business assets,(people,equipment, offices and hospitals) under federal ownership, a private system will not be allowed to, or be able to reconstitute.




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