Potential ACOs Reluctant to Participate Under Proposed Rule

During late March, the Centers for Medicare and Medicaid Services (“CMS”) proposed a rule regarding Accountable Care Organizations (“ACOs”) and the Medicare Shared Savings Program, which will make payments of shared savings to ACOs (“Proposed Rule”). The Proposed Rule describes the amount of financial risk the participants will face and the type of data the providers will be expected to collect under CMS’ current vision for the program. Many believe in the ACO concept of higher quality care at reduced costs. However, the complaints regarding the actual Proposed Rule are numerous and multi-faceted. Even the high-profile health care centers such as the Cleveland Clinic, the Mayo Clinic, and Intermountain Healthcare, which were used as inspirations for the Medicare Shared Savings Program and its ACOs, are hesitant to participate. Among other obstacles, the financial investment that providers will need to dedicate to participate in the Medicare Shared Savings Program under the Proposed Rule (e.g., to add technology and staff necessary to track the quality data to be collected) may prove to be a barrier to their participation. CMS officials are aware of the issues raised by the Proposed Rule. Dr. Donald Berwick, the Administrator of CMS, has expressed CMS’ desire and commitment to cooperate with health care providers to work out the problems.

For more information on Accountable Care Organizations, please contact Abby Pendleton, Esq., Adrienne Dresevic, Esq., Carey F. Kalmowitz, Esq., or Esq. at (248) 996-8510 or (212) 734-0128, or visit the HLP website.