In a letter (PDF) to CMS Administrator Dr. Donald Berwick, the leaders of 17 health systems said they are encouraged by the CMS' recent Pioneer ACO model but that the agency's proposed rule on accountable care organizations does not adequately advance the aims of cost reduction and improved outcomes.
Health system CEOs urge changes to proposed ACO rule
The CEOs represent health systems in all regions of the country—from Yale New Haven (Conn.) Health System to Seattle-based Swedish Medical Center and from to Advocate Healthcare, Oak Brook, Ill., to New Orleans-based Ochsner Health System. They said the proposed rule "insufficiently advances the dual goals of cost reduction and improved patient outcomes because of excessive focus on process, regulatory regime and enhanced risk to providers."
The providers suggested that the proposed rule could be improved by making changes to provisions regarding retrospective attribution, start-up capital expenditures, shared-savings percentages, the number—and calculation of—quality metrics, and antitrust guidance. They recommended, for instance, prospective attribution, contending that this would put the provider in a “more powerful position to influence the care process.”
The system leaders also asserted that implementing 65 clinical quality measures in the first year would be a "substantial practical constraint" and recommended phasing in quality metrics over time. For shared savings, the CEOs proposed three strategies: Lower the savings threshold from 2%; reduce the minimum savings rate for a Medicare ACO with a lower enrollment; and increase the percentage of savings that is shared with the ACO after the threshold is met.
Final comments to the CMS on the proposed rule are due by June 6.
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.