The American Medical Association said independent doctors should have legal leeway to remain so without violating fraud or anti-kickback laws in upcoming regulations for accountable care organizations, a payment model to be tested by Medicare under the healthcare reform law. The AMA released its accountable care principles that were adopted during a policy meeting in San Diego.
AMA establishes principles regarding ACOs
Medicare may pay provider networks a bonus based on quality and cost-saving targets starting in 2012 under the reform law.
Hospitals, doctors and private insurers have scrambled to prepare and launch commercial efforts, but concerns about market consolidation and potential legal barriers have raised questions about how such networks will take shape.
The AMA called for explicit exemptions for accountable care networks under antitrust law. The Federal Trade Commission chairman said in October that authorities would create a safe harbor that would allow networks to operate legally.
The AMA also laid out policies for accountable care payment and governance. ACOs that spend less than the national average should receive bonus payments, the group said. The CMS should test multiple incentive models, such as bonus payments and capitation, and ACOs that accept financial risk “must abide by the financial solvency standards” of risk-bearing organizations, the AMA policy said. ACO boards must be independent from participating hospital boards and must have a sufficient number of doctors to ensure medical decisions are made by doctors.
The principles also outline the physician group's position on some unsettled issues for how the accountable care groups should operate. Patient enrollment in an ACO should be voluntary and doctors must give written consent to participate, the AMA said.
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