• Interest groups go to work on ACOs

    From the Washington Post:

    With regulators planning to issue rules for ACOs in the coming weeks, some prominent doctor and hospital groups are pushing for features that some experts say could undermine the overall goal – improving care while containing costs. They’re seeking limits on how the quality of their care will be judged, along with bonus rules that would make it easier for them to be paid extra for their work and to be paid quickly.

    Hospital and doctor groups also want to avoid being held financially accountable for patients who go outside an ACO for care. And the groups are resisting efforts to penalize them if they miss savings targets, according to letters they’ve sent to CMS.

    Insurers, meanwhile, are pushing CMS to put a tighter rein on ACOs. They are fearful that ACOs will try to make up lost revenue from Medicare by charging privately insured people more or coaxing them to get more treatments. Insurers also worry that ACOs will give doctors and hospitals more power to set health-care prices in the private market.

    Some people who came up with the ACO concept are also worried that CMS might give providers too much leeway.

    Uh, yeah. This is where the rubber meets the road. This is why we need an even stronger IPAB. As things stand, cost control is–or seems to be–a mirage. Not surprising. Accounting for politics, nobody knows how to solve this. Nobody.

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    • seems like a strange concern. Every quality model I’ve worked with the denominator is always some version of ‘patients seen’ for some set number of visits per year. If anything, but attaching dollars to the quality goal, a denominator requiring that the patient is seen in the facility should encourage ACO’s to work on patient retention.

      that said, I think it might be valid to worry about some of the targets as there’s really no benchmark data on ACO savings yet. I think it’d be reasonable to request a several year period of ‘pay for reporting’ followed by pay for performance (something like PQRI).