FAH presses for safe harbor regarding ACOs

In an Oct. 27 letter to the CMS, the Federal Trade Commission and HHS' inspector general's office, the Federation of American Hospitals offered comments on accountable care organizations (PDF) following an ACO workshop that the three federal agencies hosted earlier this month.

Of particular interest, the letter noted, is whether—and how—the government would establish a safe harbor so that qualifying ACOs can have a degree of certainty when dealing with commercial payers.

“The FAH strongly believes that such a safe harbor is necessary,” the 11-page letter said. “The absence of such a safe harbor will retard the spread and potential benefits of ACOs, both in Medicare and the commercial market,” it continued, adding that this will develop from a host of factors. “First, most providers do not seek to organize themselves solely around participation in the Medicare program. Second, the effort required to build an ACO solely for a Medicare population may be cost prohibitive. Third, the pursuit of the ‘Triple Aim’ goals of the ACO effort should be shared and encouraged into the population as a whole.” The “triple aim” at the CMS has been defined as one that seeks to improve care, lower costs and reduce the need for care through prevention.

The letter addressed other issues, including a response about whether there are certain types of ACOs that seem to threaten competition more than others. The federation—which represents nearly 1,000 investor-owned or managed community hospitals and health systems—says it is concerned about any structure that would affect a level playing field among the potential competitors that may be interested in forming an ACO. That is why the group said it’s important to create the flexibility that “will allow an independent medical staff membership to participate on a level basis with hospital-employed physician base or a tightly affiliated faculty practice plan.”