No time for cynicism on ACOs: AMGA panel

Dr. Robert Nesse, chairman-elect of the American Medical Group Association, offered a clear take-home message to the AMGA members gathered Friday for a panel discussion on accountable care organizations at the association's national conference in National Harbor, Md.: "Don't waste time being cynical."

That means that doctors have to start preparing now for a changing regulatory and care-delivery environment, Nesse said. "Right now, I think we'll be successful," he said.

Nesse's remarks came during a discussion of the ACO regulations proposed by the CMS, which the AMGA feels need a major rewrite. Others on the panel included Dr. Al Fisk, chief medical officer at the 300-physician Everett (Wash.) Clinic, and Linda Leckman, an AMGA board member and vice president of Salt Lake City-based Intermountain Healthcare and the CEO of the Intermountain Medical Group. Three physician members of Congress were also expected to participate in the panel, but Reps. Dr. Michael Burgess (R-Texas), Dr. Bill Cassidy (R-La.) and Dr. Nan Hayworth (R-N.Y.) were called back to Capitol Hill to vote on federal budget measures.

Leckman echoed Nesse's remarks that organizations had to work toward accountable care while simultaneously working to improve the rules the government was proposing for ACOs.

"For us, to just reject is just not an option," she said. "What is important to remember is the endgame: better care, less expensive care, more effective care."

The conversation started with discussion of a recent poll that indicated public dissatisfaction with the nation's healthcare system, and Leckman tied this public sentiment to difficulties in accessing care and frustration with financial incentives that reward volume over value. "Fee-for-service doesn't always result in the highest quality," she said.

When asked if the proposed regulations were a path to rationing, Leckman replied, "If you took it down to a fairly harsh level, one could say yes," but she clarified that the inclusion of quality measures on patient satisfaction and care management are the "guard that's built in" to prevent that.

Fisk noted that the 65 quality measures included in the proposed regulations had merit but said there should be a smaller starter set and that more measures should be phased in over time. He added that, as the rules stand, he doesn't know of any organization that would participate in the CMS' program. However, he said, "Our job is to respond individually and collectively in an organized way so CMS understands that change is necessary."