The ACO concept -- while arguably still pretty
foggy -- is certainly attracting a lot of attention in the health sector. But, are ACOs going to eat up the
non-integrated private sector? Certainly not imminently. But the ACO concept is worth some serious
consideration by the profession. The ACC is certainly going to explore how the
concept might be beneficial to some members and patient populations. There is
potential here -- maybe.
Affordable Care Act prevails in its
legal challenges (and if it somehow does
not, something similar to it needs to be created post haste to deal with the
rising numbers of uninsured persons and costs of US health care), ACOs represent
are a major element of the law, and the Secretary of Health and Human Services will have broad authority to
provide financial incentives for them. Money is promised to flow here.
In fact, ACOs
have become central to current thinking about how American health care might find ways to bend the cost
curve and better organize health care. Huge conferences occur every week in DC
it seems on what ACOs might be and how to build one. The idea is to bring
doctors, hospitals, and health plans and Medicare (and Medicaid) together in
ways that would hopefully streamline health care, improve patient health status
and outcomes, reduce variation in care, and lower costs. Sounds like a fairy tale, doesn’t it? But, hospitals are wildly buying
up physician practices to be ready to create ACOs. Health plans, particularly United and CIGNA, have already started buying up medical groups to build ACO networks
and pilots -- health plans do NOT want to see hospitals predominate in this proposed
transition of the delivery system. Even many physician IPAs and medical groups in
California, Colorado, and elsewhere are similarly gearing up. All are hoping to
land CMS “innovation center” grants. ACO
policy wonks and consultants are multiplying and are in evidence everywhere one
activity is all certain to keep churning along, driven by market forces, even
if the ACA controversy drags on through next year. However, the ACA
directs the Secretary of HHS and CMS
to publish regulations on how ACOs will be structured and financed. The big
question is -- where are the proposed regulations from CMS? The ACO regulations were promised in January, then
February, and now it’s mid-March. Whassup?
that the regs have
gotten hung up over anti-trust concerns
with DOJ and the FTC (Federal Trade Commission). Since ACOs
will likely only be effective if they can bring physicians, hospitals, and
health plans together to cover a
large population and geography, issues around market dominance and anti-trust develop.
of the ridiculous aspects of current US anti-trust policy that health plans are
exempted from most market domination provisions. Hospitals and doctors are not.
The Secretary supposedly has authority in the Affordable Care Act (ACA) to
waive some anti-trust concerns for ACOs, and this is likely to be challenged
by the FTC and the current Congress. So, the regs are in limbo. But that’s not
stopping the action sans ‘regs.
Modern Health Care this
week carried a story on an anti-trust debacle developing in Nevada as an ACO there tries to take
shape. The Nevada attorney general's office and the FTC
have launched an inquiry into a patient-care collaboration between Reno-based Renown Health and a local cardiology practice, Sierra Nevada Cardiology Associates. The alliance was the first step
in forming an accountable care organization for the two organizations.
"Their interest is not
unexpected given the size of the transaction, and we've met and are cooperating and providing
requested information," said Terri Hendry, Renown's spokeswoman, said in the article. "We are
confident that this change is in the best interest of consumers and will result
in improved coordination of heart services in the region." The ACC is
monitoring this process and the entire process of the amazingly rapid changes
occurring in the US health care delivery system around integration, physician
employment, population based health systems, and payment reforms. Whew. A lot is happening, folks, despite
what Congress thinks they can control.