Published by: Sarah Mutinsky on 10/27/2010 9:51:35 AM
The October 5th workshop with the Centers for Medicare and Medicaid Services (“CMS”), the HHS Office of the Inspector General (“OIG”), and the Federal Trade Commission (“FTC”) spawned discussion about many critical issues for hospitals and other providers as the federal government sets up not only Accountable Care Organizations (“ACOs”) under the Medicare Shared Savings Program created by the health reform legislation, but also delivery system reform efforts more generally.
In the midst of an often technical discussion centered on how the federal government could alleviate potential legal barriers to support the creation of ACOs, Nora Super from the AARP reminded the panelists and others in attendance that while their organizations may have been going to a lot of conferences on this topic lately, the AARP is not getting calls from Medicare patients asking when they are going to get their ACOs. This comment injected an important lesson back into the discussion, and one that NAPH members know well from their long experience in tailoring their systems to the needs of their communities—that in the end, these programs need to transform the delivery system in a way that demonstrates real value to patients in order to succeed.
To be sure, the questions from CMS, OIG and the FTC made clear that there are many open, complicated questions that must be addressed in the proposed rule on Medicare ACOs expected this November. The federal government must balance the need for clarity to limit risks for providers with the need for flexibility to allow providers to experiment with the most effective model for their communities. They must balance support for innovation with a concern to prevent abuse and anticompetitive behavior. And they must struggle with how to support reforms meant to fundamentally change the way we deliver care while enforcing laws tailored to the existing system.
Of particular interest for NAPH hospitals and health systems, the government may need to address questions raised by panelists as to the appropriate role for hospitals in ACOs. Among other things, the panelists discussed whether ACOs will lead hospitals to acquire practices in their communities in order to benefit from shared savings, or whether federal efforts to limit barriers to forming ACOs will allow hospitals to coordinate with other providers without such consolidation. In addition, although it is clear that the federal government wants to structure the Medicare ACO program to encourage similar programs with other payers, the role and particular challenges for ACOs in Medicaid does not appear to be a primary focus of CMS.
While it remains to be seen exactly how CMS, OIG and FTC, will address these and many other questions, their efforts are likely to be made with patient value in mind and with the goal of accomplishing what CMS Administrator Don Berwick reminded attendees is the “Triple Aim” in health care: “better care for individuals, better health for populations, and lower per capita costs of care without any harm whatsoever to patients.”
Sarah E. Mutinsky
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