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Supportive of intent of ACO proposed rule, ACP expresses concern
Date:6/2/2011

In a 10-page letter addressed to Donald Berwick, administrator of the Centers for Medicare and Medicaid Services, ACP today said:

The ACP strongly supports the intent of the proposed rule, and believes that an ACO model has the potential of supporting such important care delivery goals as enhancing quality, efficiency, integration, and patient-centeredness. The College is also pleased that the foundation of care under this payment model, as reflected in the proposed rule, is primary care. There is substantial research evidence derived from both domestic and international settings that a strong primary care foundation is the essence of an effective and efficient healthcare system.

We are concerned, though, that the current requirements proposed for acceptance as an ACO by Medicare under this program sets too high of a bar for participation by many internal medicine physicians, especially internal medicine specialists in primary and comprehensive care of adults who practice in smaller, independent physician practices. The required administrative, infrastructure, service delivery, and financial resources and the need to accept risk will effectively limit participation to those few large entities already organized under an ACO-like structure; that already have ready access to capital, substantial infrastructure development, and experience operating under an integrative service/payment model (e.g. Medicare Advantage). Even these entities have questioned the "business case" for adoption of the ACO model as outlined in the proposed rule. We do believe that the Center for Medicare and Medicaid Innovation's (CMMI) recent release of the Pioneer option, with its increased administrative flexibility and ability to earn a higher share of savings than allowed in the proposed rule, may effectively address this issue for the larger, already prepared players. We also are intrigued by the proposal from CMMI for an "advance payment" initiative
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Contact: David Kinsman
dkinsman@acponline.org
202-261-4554
American College of Physicians
Source:Eurekalert

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