• ACO legislative details

    Reader Ryan Stevens encouraged me to take a closer look at what the ACA legislation actually says about ACOs. Fortunately, the job is made dramatically easier by HealthReformGPS. In two separate posts the amazingly thorough staff of that blog cover the nitty-gritty on ACO provisions as they pertain to Medicare and Medicaid.

    I encourage interested readers to check out the posts themselves. I’m not going to attempt to summarize them because, frankly, it’s too boring. However, in the very lengthy section on open questions, the following part jumped out at me:

    How will federal antitrust enforcers view the establishment of ACOs? Will ACOs be insulated from potential antitrust claims to the extent that the ACO providers collectively negotiate payments with private third-party payers outside of Medicare? Will ACO certification include a determination that ACO are “clinically integrated” and thus fall within the federal antitrust exception? Will the federal government create an express safe-harbor from antitrust scrutiny for ACO activities under certain conditions?

    I’d love to know the answers to those questions.

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