Stating that the initial ACO opportunity should not be for everybody, an article published in the New England Journal of Medicine says CMS shouldn't be too quick to lower the ACO bar in response to stakeholder comments on the controversial proposed rule.
The article, authored by Paul B. Ginsburg, PhD, says organizations may be better off spending on ACOs now rather than losing money as fee-for-service rates ratchet down. Dr. Ginsburg identifies four controversial aspects of the proposed rules in the article.
1. CMS opted for retrospective attribution to promote more organized care delivery without interfering with beneficiaries' choice of providers. While retrospective attribution will be more accurate than attribution based on beneficiaries' prior use, ACOs won't know which beneficiaries they're accountable for until at least six months after each year in a three-year contract. This shouldn't make much of a difference, according to Dr. Ginsburg. "The agency hopes that ACOs will work to improve care for all Medicare beneficiaries, not only those attributed to the ACO, in which case the delay in attribution should not have major consequences," he said in the article.
2. Setting a benchmark on the basis of an ACO's historical costs is the only fiscally responsible way to conduct a voluntary program. Dr. Ginsburg says CMS should place a higher priority on getting inefficient organizations into the ACO program rather than attracting those that are already efficient, according to the article. If ACOs do take off and become a large part of the healthcare delivery system, Dr. Ginsburg says an evolution towards national or regional benchmarks is to be expected and ACOs that are already efficient will then receive larger rewards.
3. Quality reporting or surveys can be expensive for providers. Dr. Ginsburg says CMS should focus on value in quality measurement along with care. The agency has stated quality measurements will evolve throughout ACO development, but this increases risks for ACOs. It would be better for CMS to commit to stability in quality measurement, according to the article.
4. Providers should consider ACOs as more than a short-term business opportunity. Dr. Ginsburg says it may be better to spend now in order to save later, avoiding the consequences of decreased fee-for-service rates. "The shift from volume-driven to value-driven payment is inevitable," Dr. Ginsburg says in the report, "and getting limited shared savings while embarking on the needed investments to build the infrastructure and relationships for improving delivery is better than getting no rewards under the fee-for-service system."
Related Articles on ACOs:
7 Senators Ask CMS to Withdraw Proposed ACO Regulations
CMS Shares Specific Provisions for Rural Providers and ACOs
As Interest in ACOs Wanes, It's Time to Do the 'Next Right Thing'
The article, authored by Paul B. Ginsburg, PhD, says organizations may be better off spending on ACOs now rather than losing money as fee-for-service rates ratchet down. Dr. Ginsburg identifies four controversial aspects of the proposed rules in the article.
1. CMS opted for retrospective attribution to promote more organized care delivery without interfering with beneficiaries' choice of providers. While retrospective attribution will be more accurate than attribution based on beneficiaries' prior use, ACOs won't know which beneficiaries they're accountable for until at least six months after each year in a three-year contract. This shouldn't make much of a difference, according to Dr. Ginsburg. "The agency hopes that ACOs will work to improve care for all Medicare beneficiaries, not only those attributed to the ACO, in which case the delay in attribution should not have major consequences," he said in the article.
2. Setting a benchmark on the basis of an ACO's historical costs is the only fiscally responsible way to conduct a voluntary program. Dr. Ginsburg says CMS should place a higher priority on getting inefficient organizations into the ACO program rather than attracting those that are already efficient, according to the article. If ACOs do take off and become a large part of the healthcare delivery system, Dr. Ginsburg says an evolution towards national or regional benchmarks is to be expected and ACOs that are already efficient will then receive larger rewards.
3. Quality reporting or surveys can be expensive for providers. Dr. Ginsburg says CMS should focus on value in quality measurement along with care. The agency has stated quality measurements will evolve throughout ACO development, but this increases risks for ACOs. It would be better for CMS to commit to stability in quality measurement, according to the article.
4. Providers should consider ACOs as more than a short-term business opportunity. Dr. Ginsburg says it may be better to spend now in order to save later, avoiding the consequences of decreased fee-for-service rates. "The shift from volume-driven to value-driven payment is inevitable," Dr. Ginsburg says in the report, "and getting limited shared savings while embarking on the needed investments to build the infrastructure and relationships for improving delivery is better than getting no rewards under the fee-for-service system."
Related Articles on ACOs:
7 Senators Ask CMS to Withdraw Proposed ACO Regulations
CMS Shares Specific Provisions for Rural Providers and ACOs
As Interest in ACOs Wanes, It's Time to Do the 'Next Right Thing'