Independent doctors should have legal leeway to remain independent without violating fraud or anti-kickback laws in upcoming regulations for accountable care organizations, according to the American Medical Association. The AMA recently released its principles for accountable care organizations, a payment model that Medicare will test under the healthcare reform law, that were adopted during a policy meeting in San Diego.
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, according to the group.
Additionally, 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, according to the AMA policy. ACO boards must be independent from participating hospital boards and they must have a sufficient number of doctors to ensure medical decisions are made by doctors.