The Alliance of Specialty Medicine, an association of specialty medical societies, wants the CMS to delay for at least a year its implementation of a demonstration project for patients known as dual-eligibles who are eligible for both Medicare and Medicaid.

In a letter to Marilyn Tavenner (PDF), acting CMS administrator, the alliance members wrote they are concerned that access to care will be disrupted because of potential problems with the demonstration resulting from a swift and relatively large implementation among the states applying to join. "While the goal of the program is to eliminate duplication of services for these patients, expand access and lower costs to this vulnerable population, we are deeply concerned about unintended consequences that are likely to impede on the initiative's stated aim," the authors wrote.

Other groups also have expressed concerns about the program, including the Federation of American Hospitals.