Proponents argue that accountable care stands to be an efficient alternative to paying for each test, clinic visit or procedure. But even among its advocates, the proposed model has raised concerns about market consolidation and patient protection as providers accept more financial risk for the cost of medical care.
Regulators are scrambling to draft rules for how such networks can operate without violating anti-kickback and fraud-and-abuse laws. The CMS, HHS' office of the inspector general and the Federal Trade Commission held a one-day workshop in early October on legal issues raised by accountable care.
Now the CMS is seeking comment, “particularly from the physician community.” Independent doctors appear to be given special consideration in the agency's plans: “We are seeking to advance ACO structures that are organized in ways that are patient-centered and foster participation of physicians and other clinicians who are in solo or small practices.”
The American Medical Association has some ideas. The AMA last week adopted principles calling for rules that are "sufficiently flexible to allow physicians to collaborate with hospitals in forming ACOs without being employed by the hospitals or ACOs."
So what does the CMS want to know? How could payment models or financing give small group practices access to needed capital? How should the CMS identify Medicare patients for whom bonuses would be paid? How should the agency pay the bonuses? What criteria should it use to evaluate quality; patient-centeredness and the experience of patients and providers?
If you're curious, you can read comments as they are submitted at www.regulations.gov. (We also welcome comments here on potential pitfalls or promises of accountable care networks.)