Answers on ACOs

John Commins, for HealthLeaders Media , May 13, 2011
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4. The CMS-mandated antitrust review
            process for certain other ACOs

5. Options for ACOs to gain additional
            antitrust clarity if they fall outside
            the safety zone but below the CMS-
            mandated antitrust threshold


The FTC and DOJ will evaluate applicants based on the ACO’s share of services in each participant’s primary service area. ACOs with high PSA shares may pose a higher risk of being anticompetitive, could restrict competing ACOs, and could allow an ACO to raise prices charged to commercial health plans above competitive levels, the
agencies said.

Depending on an ACO’s range of PSA shares, CMS may mandate, or an ACO may choose to seek, an expedited antitrust review. An ACO will submit its request for an expedited 90-day review to both the FTC and DOJ, and the agencies will determine which of the two will review the request. In addition, the FTC and DOJ will establish a Joint ACO Working Group to discuss issues arising from ACO reviews.

The two agencies have opened a public comment period on the proposed policy statement through May 31 on issues including whether:

n          The proposed policy statement
            should be changed in any respect

n          Other data sources exist that
            ACO applicants could use to
            determine relevant PSA shares for:
            1) physician services rarely used by
            Medicare beneficiaries (e.g., pediat-
            rics, obstetrics), and 2) inpatient
            hospital services located in states
            where all-payer hospital discharge
            data are unavailable

n          Providing the documents
            and information for an expedited
            antitrust review will present an
            undue burden on ACO applicants

Reported by John Commins on April 1, 2011.
Reprint HLR0511-1


John Commins is a senior editor with HealthLeaders Media.

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