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Details and Bedevilment: New Data Validate Concerns & Raise More Questions About ACOs

First few Article Sentences

New data available from both the Centers for Medicare and Medicaid Services (CMS)i and the Premier healthcare allianceii offer health care providers their best opportunity yet to determine whether participating in an Accountable Care Organization (ACO) would be beneficial. While the theory of ACOs is that better care coordination and use of evidence-based practices by healthcare providers can both improve quality of and access to care for patients while generating substantial savings over current treatment and reimbursement practices, especially for high-cost patients, the new data suggest that more than the usual bedevilment is in the details of reimbursement for ACOs and that further refinement and flexibility than currently is in the models proposed by CMS will be necessary to realize this triple win and meaningfully reduce growth in the cost of care.

The initial model that CMS put forward this spring in its proposed regulations for the Medicare Shared Savings Programiii raised a number of questions and concerns for providers. For example, comments from the American Medical Group Association (AMGA) demonstrate that while the Shared Savings regulations resolved some issues (e.g., removing the restriction preventing physicians from participating in multiple ACO programs), many issues remain.iv Among the most significant of these are (1) retrospective attribution of patients; (2) increased administrative burden from reporting and care management requirements; and (3) insufficient rewards to support the investments.

Miles, Anthony, R.


Stoel Rives LLP

Accountable Care Organizations

August 31, 2011

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