The Cleveland Clinic's chief executive, in a letter to the head of the CMS (PDF), called Medicare's plans for accountable care organizations prescriptive, burdensome and discouraging. Dr. Delos Cosgrove, president and CEO of the 11-hospital system, said its officials finished a review “disappointed generally” with the proposals released two months ago to create Medicare ACOs.
ACO regs disappoint: Cleveland Clinic
The highly anticipated plans, called for by the Patient Protection and Affordable Care Act, have been largely rejected by hospitals and physicians as too onerous with too little potential financial gain. Under accountable care contracts, Medicare could pay bonuses or demand repayment from providers based on the quality and cost of care for enrollees.
Cosgrove said providers would face “real uncertainty” as to whether they could achieve bonuses. The CMS should reconsider a savings threshold which provider must reach before they qualify for incentive payments. Hospitals and doctors should be eligible for larger bonuses and have the option for payment that does not include potential penalties. The CMS should also require providers have financial reserves, similar to insurers, rather than hold back 25% of bonus payouts each year to protect against possible future penalties.
Doctors and hospitals would be required under Medicare accountable care to report some quality measures for the first time, he said. “A learning period is warranted,” the letter said. The CMS should jettison quality measures for ACOs already required by other regulations, such as hospital-dependent measures of quality. The Cleveland Clinic also urged federal officials to track outcomes rather than process measures.
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