As proposed, the rules are flawed and costly, and an exemption for the smallest groups would be meaningless, the AMA said in a comment letter (PDF).
The association rejected the proposed method to screen for market clout as ineffective. “We firmly believe the (primary service area) model is biased towards creating artificially small geographic markets that overstate an ACO's ability to exert market power.”
The AMA also called for the Justice Department and the FTC to grant a greater share of organizations exemption from scrutiny than authorities proposed in March.
Accountable care groups with 40% or less of Medicare fee-for-service business within local service areas should be exempt from antitrust review, said the AMA. Rules proposed by the Justice Department and FTC put the threshold at 30%.
ACOs with more than 40% but no more than 60% of the local market should be considered for voluntary, but not mandatory, antitrust review, said the AMA letter. Under the rules proposed in March, accountable care groups with half the area's market or more would face a mandatory review.
Rules should more clearly allow exclusive contracts for midsize accountable care groups not subject to mandatory antitrust review, the AMA argued.
The AMA also dismissed one proposed criteria to qualify for the antitrust exemptions: efforts must have begun after March 23, 2010, for which the association said it could see no “plausible rationale.”