…will US Senators once again save Hawaii from its elected officials? NO other Hawaii media organization has covered this story….
News Release from American Academy of Orthopedic Surgeons
(Note, the plan referred to by Gov Neil Abercrombie as “Medical Homes” is identified as ACOs or Accountable care Organizations in this report from the American Academy of Orthopedic Surgeons and the US Senators’ letter.)
In a letter to the secretary of U.S. Department of Health and Human Services (HHS) and the administrator of U.S. Centers for Medicare & Medicaid Services (CMS), seven members of the U.S. Senate Finance Committee have raised concerns over a proposed rule regarding the implementation of accountable care organizations (ACOs) under the Patient Protection and Affordable Care Act. The legislators state that a number of medical organizations, including "all ten members of the nationally recognized Physician Group Practice (PGP) CMS demonstration project" have expressed reservations over the regulation. In addition, the writers point out that a recent report from American Hospital Association estimated that ACO startup costs would be at least 10 times higher than costs cited in the proposed rule. The senators have asked HHS to withdraw the proposed rule and craft a new version with input from stakeholders.
PDF version of the letter HERE.
* * * * *
May 24, 2011
The Honorable Kathleen Sebelius U.S. Department of Health and Human Services 200 Independence Avenue, SW Washington, DC 20201
The Honorable Donald W. Berwick, M.D. Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services 200 Independence Avenue, SW Washington, DC 20201
Dear Secretary Sebelius and Administrator Berwick:
We are writing to express our serious concerns regarding the Department of Health and Human Services’ (HHS) recently-proposed regulation implementing Section 3022 of the Patient Protection and Affordable Care Act – the Medicare Shared Savings Program, commonly referred to as Accountable Care Organizations (ACOs).
Rewarding high quality, efficient providers based on positive patient outcomes in an ACO model is a concept that sustained bipartisan support throughout the contentious health care debate of the 111th Congress. Accordingly, we sincerely appreciate the time and effort the Administration has invested in developing the draft ACO regulation.
However, we have been struck by the increasingly diverse chorus of concerns many of our nation’s leading health care institutions have raised in recent days about the proposed ACO regulation. Innovative integrated health providers as the Billings Clinic (MT), Intermountain Healthcare (UT), the Cleveland Clinic (OH), Mayo Clinic (MN), Sutter Health (CA), Marshfield Clinic (WI) have expressed serious concerns with the details of the proposed rule.
These providers are not the only ones concerned. In fact, all ten members of the nationally-recognized Physician Group Practice (PGP) CMS demonstration project have expressed “serious reservations” about the regulation’s current construction. It is troubling that their participation is doubtful, since these PGP members and experience are cited more than 75 times in your Agency’s 400+ page proposed rule as a model for the ACO regulation.
One clear disincentive was identified last week. The American Hospital Association released a report noting that actual ACO start-up costs will likely be at least 10 times higher than the estimated costs cited in the proposed rule.
The concerns over the ACO regulation from some of our nation’s most knowledgeable and innovative health care providers are clear. Incentives and accountability are misaligned. Detailed requirements are complex and return on investment is uncertain.
Unfortunately, based on the feedback we have from providers around the country, we conclude that the proposed ACO regulation will fail to accomplish its purpose. Therefore, we respectfully ask that you withdraw this proposed rule and re-engage experienced stakeholders to craft a new rule that fulfills the promise of ACOs.
In principle, the model of an ACO still holds promise. To truly improve the Medicare program for the beneficiaries of today and tomorrow, more ACO-like coordination and collaboration among providers and beneficiaries is undoubtedly a worthwhile goal. An ACO model that can increase provider coordination and patient accountability would be a step in the right direction compared with today’s fragmented delivery system. However, it is increasingly clear this proposed rule misses the target.
We look forward to the Department redesigning a regulation that will truly help accomplish our shared goals for patients, providers, and taxpayers alike: better care at lower costs. In the weeks ahead, we look forward to your working with you and other Administration leaders on this matter.
- Tom Coburn, M.D. U.S. Senator, Oklahoma
- Mike Crapo U.S. Senator, Idaho
- John Cornyn U.S. Senator, Texas
- Jon Kyl U.S. Senator, Arizona
- Mike Enzi U.S. Senator, Wyoming
- Pat Roberts U.S. Senator, Kansas
- Richard Burr U.S. Senator, North Carolina
# # #
* * * * *
RELATED: Abercrombie’s Medical Homes scheme rejected by Mayo Clinic, other top clinics
* * * * *
RELATED: CMS Releases Proposed Regulation on Accountable Care Organizations
The Centers for Medicare & Medicaid Services (CMS) has published a proposed regulation implementing Section 3022 of the Affordable Care Act (ACA). The ACA requires the HHS secretary to establish the Shared Savings Program by January 1, 2012. The program is intended to encourage providers of services and suppliers to create a new entity, which the statute terms Accountable Care Organizations (ACOs). Participating entities in an ACO would be charged with improving health and experience of care for individuals.
The new CMS rules provide guidance to provider organizations in setting up exchanges of healthcare data to improve care and reduce costs. According to the HHS website, HHS worked closely with other federal agencies to “ensure that providers and suppliers have the clear and practical guidance they need to form ACOs without running afoul of the fraud and abuse, antitrust, and tax laws.”
Consequently, the following notices also were released along with the publication of the ACO rules:
- A joint CMS and OIG notice and solicitation of public comments on potential waivers of certain fraud and abuse laws in connection with the Medicare Shared Savings Program;
- A joint FTC and DOJ proposed antitrust policy statement; and
- An IRS notice requesting comments regarding the need for additional tax guidance for tax-exempt organizations, including tax-exempt hospitals, participating in the Medicare Shared Savings Program.
For more information, contact Thomas Phan.
* * * * *