The American Medical Association warned the CMS that the government's plans for Medicare accountable care organizations are so restrictive as to likely discourage many physicians from participating in the organizations. "This would be a missed opportunity to fully explore this new care delivery and payment model for the Medicare program," outgoing AMA Executive Vice President and CEO Dr. Michael Maves wrote in a letter (PDF) to CMS Administrator Dr. Donald Berwick.
AMA cautions CMS on ACO rules
Because the model is untested, according to Maves' letter, the CMS should issue an interim final rule to the agency has flexibility to make changes.
Draft rules for the Medicare accountable care program that is scheduled to begin in January 2012 were released in late March, and the deadline for public comment is June 6. Medicare would pay bonuses or collect penalties from accountable care organizations based on measures relating to quality and health spending.
The CMS should give accountable care organizations one option that won't put them at risk for potential losses, according to Maves' letter. It would be inappropriate for every ACO to take on risk because they lack data to project possible financial losses; current proposed rules do not adjust payment for more-complex, costly patients; and patients have no incentive to seek care from an ACO, according to the AMA.
The letter also asserted that small physician groups lack access to needed capital for ACO start-ups. Medicare should adopt alternative payment models, such as treatment warranties or partial capitation, to help offset upfront ACO costs, and in the early years of the program, providers should be required to meet fewer quality measures than the 65 proposed, according to the letter.
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