Reporter's Notebook: ACOs and the Gingrich connection

After being close to disowning it last year, the American Medical Group Association was back to touting its role in the creation of accountable care organizations at its annual conference last weekend in San Diego, and it even provided a little more context and back story—which included giving credit to a somewhat unlikely catalyst.

What George Roman, AMGA senior director of health policy, said and former AMGA Vice President of Public Policy Chet Speed later confirmed, was that, essentially, the ACO-creating provision might never have been included in the Patient Protection and Affordable Care Act if it weren't for former U.S. House Speaker Newt Gingrich.

So, even as his presidential hopes may be fading, his lasting influence might be found in the growing interest in accountable care.

At a March 9 session updating members on current happenings on Capitol Hill, Roman said the genesis of ACOs began with an invitation to make a presentation on the concept at a program sponsored by Gingrich's Center for Health Transformation. After the presentation, Roman said a Senate Finance Committee staffer approached Speed and asked him “to give us some language on this” at which point, Speed's knees almost buckled.

He recovered, however, some draft legislation was written and presented and Roman said, “what we proposed was largely included” in the final version of the law. Roman also noted that this was the single largest law or regulation he ever personally had a hand in—adding, however, that the ACO provision amounted to only about 2,000 of the law's 500,000 or so words.

Speed, now the Cleveland Clinic's executive director of federal government relations, confirmed the story, saying that the AMGA had met earlier with the Center for Health Transformation staff and was told “Newt really wants to hear this sort of thing.”

So, Gingrich called for a meeting that was held in December 2008. Speed said Capitol Hill staffers were invited, and it was attended by the AMGA along with representatives of some of its member organizations that participated in the CMS' Physician Group Practice Demonstration: Billings (Mont.) Clinic; the Everett (Wash.) Clinic; Geisinger Health System, Danville, Pa.; Marshfield (Wis.) Clinic; and Park Nicollet Health Services, St. Louis Park, Minn.

“They just had a great story to tell,” Speed said of the group practices. “And, lo and behold, one of the finance staffers said ‘could you write it up and present it to us?'”

So, did his “knees buckle” as Roman said? Maybe not exactly, but Speed says that it's a big moment in any advocacy association staffer's career when they are specifically asked to contribute to developing legislation in such a way.

“It was a very happy moment, and I think we did a very decent job of providing draft legislation,” Speed said, adding that others—including the CMS and the Medicare Payment Advisory Commission—later “touched it” before a final version was settled on.

Of course, the jubilation subsided when the CMS released its proposed rule, and this was reflected in the AMGA's recently released annual report to members for 2011 in which it's described how the proposal “fell far short of our hopes and we were as deflated as we had been overjoyed at passage of the law.”

In the revised final rule, however, Roman said the CMS “did essentially what we asked,” and Speed agreed.

“To their great credit, the CMS really did listen,” he said. “Don Berwick, in particular, really did listen and drove the final rule.”

David Merritt, former CEO of the Center for Health Transformation and now a senior adviser at Leavitt Partners, the consultant firm founded by former HHS Secretary Michael Leavitt, also confirmed the story.

“CHT hosted a meeting to explore what HHS could do to accelerate care coordination and quality-based reimbursement, two issues that we had studied and advocated for many years,” Merritt said in an e-mail. “I invited Senate Finance staff, Rep. Mike Burgess (R-Texas), AMGA leadership, and some participating providers from the Physician Group Practice Demonstration. We discussed the organization of the demonstration, what had worked, what hadn't, and what a new program could accomplish.”

Merritt, who is also an adviser for Gingrich's presidential campaign, was asked for his boss's official position on ACOs.

“Newt supports efforts to promote care coordination and new provider payment models that emphasize quality,” Merritt said in the e-mail. “CMS can and should incorporate these new models in public programs, but the federal government should always remember: it is incapable of innovating. It cannot be legislated or decreed through regulation. A better approach is to incorporate what is working in the private market—led by businesses, insurers, and providers—and adopt it in Medicare and other public programs.”