Insurers and healthcare providers are currently at odds over how accountable care organizations should be regulated, according to a report in the Washington Post.
ACOs — created by a provision in the healthcare reform law — encourage care coordination by allowing hospitals and physicians to share cost savings created for Medicare. The Medicare ACO program will launch in Jan. 2012, but the government is still finalizing its regulations for the program. The Department of Health and Human Services is expected to release its rules for ACOs in the next few weeks, causing many insurers and providers to work to ensure their interests are protected.
Healthcare providers are arguing for regulations that protect them from being financially penalized for not meeting targets or for when patients go to providers outside the ACO. They also seek to limit how quality of care can be judged and are pushing for measures to ensure they are paid quickly for their improvements, according to the report.
Insurers fear ACOs may attempt to make up for lost revenue on Medicare by charging them more, leveraging the ACO's new-found market power.
ACOs are expected to save Medicare $1.2 billion per year by 2019, according to the Congressional Budget Office, but success may depend on how well the regulations meet potential challenges. If regulations are too strict, too few providers may be interested in joining the programs. If they are too lax, ACOs could become a fiscal burden to Medicare, according to the report.
Read the Washington Post report on accountable care organizations.
Read more coverage on ACOs:
- Lessons From the Group Practice Demonstration for ACOs: Q&A with University of Michigan's Dr. Caroline Blaum
- Attracting Primary Care Providers to Your ACO: 4 Considerations
ACOs — created by a provision in the healthcare reform law — encourage care coordination by allowing hospitals and physicians to share cost savings created for Medicare. The Medicare ACO program will launch in Jan. 2012, but the government is still finalizing its regulations for the program. The Department of Health and Human Services is expected to release its rules for ACOs in the next few weeks, causing many insurers and providers to work to ensure their interests are protected.
Healthcare providers are arguing for regulations that protect them from being financially penalized for not meeting targets or for when patients go to providers outside the ACO. They also seek to limit how quality of care can be judged and are pushing for measures to ensure they are paid quickly for their improvements, according to the report.
Insurers fear ACOs may attempt to make up for lost revenue on Medicare by charging them more, leveraging the ACO's new-found market power.
ACOs are expected to save Medicare $1.2 billion per year by 2019, according to the Congressional Budget Office, but success may depend on how well the regulations meet potential challenges. If regulations are too strict, too few providers may be interested in joining the programs. If they are too lax, ACOs could become a fiscal burden to Medicare, according to the report.
Read the Washington Post report on accountable care organizations.
Read more coverage on ACOs:
- Lessons From the Group Practice Demonstration for ACOs: Q&A with University of Michigan's Dr. Caroline Blaum
- Attracting Primary Care Providers to Your ACO: 4 Considerations