bapifar01: Affordable Care Act Medicare provision hits provider roadblock

Sunday, 15 May 2011

Affordable Care Act Medicare provision hits provider roadblock

One of the key provisions for Medicare cost control in the Affordable Care Act is getting pushback from providers as regulators try to establish the rules for the program.

The Accountable Care Organizations provision is a voluntary program intended to "help doctors, hospitals, and other health care providers better coordinate care for Medicare patients." The ACOs would create incentives for providers to coordinate the healthcare of individual patients, from primary care providers, to hospitals, to long-term care facilities, streamlining patient information and hopefully resulting in more efficient, patient-centered care. ACOs that lowered costs and met performance standards would be rewarded. The program is supposed to be in effect January 1, 2012.

The rules for the program were proposed at the end of March, with a 60 day comment period. With two weeks left, there's significant provider push-back on the proposed rules.

[I]n an unusual rebuke, an umbrella group representing premier organizations such as the Mayo Clinic wrote the administration Wednesday saying that more than 90 percent of its members would not participate, because the rules as written are so onerous it would be nearly impossible for them to succeed.
"It's not just a simple tweak, it's a significant change that needs to be made," said Donald Fisher, president of the American Medical Group Association, which represents nearly 400 large medical groups around the country providing care for roughly 1 in 3 Americans. Its members, including the Cleveland Clinic, Intermountain Healthcare in Utah, and Geisinger Health System in Pennsylvania, had been seen as the vanguard for accountable care.

The medical groups say they are worried they will be left holding the bag for losses, that the government has designed things so there is no easy way to tell which patients are part of the program, and that there's no reliable way to adjust for patients who are sicker and require closer follow-up and more expensive treatments....

Private insurers are also experimenting with versions of the accountable care idea, but successful adoption by Medicare is seen as the key to spreading it across the country. The Obama administration had estimated as much as $960 million in savings from the first three years of the program, and bigger amounts thereafter.

This should be a no-brainer of an idea?providers talk to each other about patients and share records and treatment plans. It should work in Medicare more easily than in the private sector, presumably, since there is an overarching system in which patients are enrolled. That there's this much resistance from providers on a program that is entirely voluntary, and only applies to Medicare patients, doesn't bode extremely well for the cooperation of providers as more of the ACA programs roll out.