Do you understand the proposed ACO rule?

By Elisabeth Deckon on May 23rd, 2011

Key Points to Note in the ACO RegulationsI recently returned from the American Medical Group Association’s (AMGA) annual conference in DC where accountable care organizations (ACOs) were a hot topic of conversation. The long-awaited regulations regarding ACOs were published on March 31 so many folks were still trying to fully understand what the regulations entailed. Initially, I got the sense that most attendees were frustrated with what they had heard about the regulations and thought they were “really bad” – I heard other adjectives as well but “bad” gets the point across. As the conference continued and attendees began to better understand the rule and collaborate amongst themselves, the tone seemed to shift from “these are bad” to “we can fix them by participating during the comments period.”So what about the rule needs to be fixed?

According to AMGA, quite a few things. The organization recently submitted a letter to the CMS Administrator, Dr. Don Berwick, in which they alerted him that 93 percent of its members said they would not enroll as an ACO under the current regulatory framework. Some of their primary concerns with the rule include: the risk-sharing requirement; the baseline for patient severity; retrospective attribution; quality measurement requirements; and the minimum savings requirement. The proposed rule is complex and sets a new Medicare reimbursement framework. Understanding all of the contents of the rule will be necessary to evaluate and make participation decisions. If you don’t fully understand all of its contents, here’s a 20 minute overview of key elements in the proposed rule that may be helpful.The comments period for the rule closes on June 6, 2011. It will be interesting to see what the final rule includes…