The Medical Group Management Association has submitted its formal comments on the proposed rule for Medicare ACOs, expressing concern over a program that has "already established a bias against medical group participation," according to an organization news release.
In a letter to Centers for Medicare and Medicaid Services, MGMA cited the following problems with the proposed ACO rule:
• The cost of ACO development and ongoing operation will be too high compared to the potential financial benefits.
• Financial benefits are not only too small, but also too uncertain.
• Regulatory risks under joint notices from CMS and the Office of the Inspector General, and the Federal Trade Commission and Department of Justice, are substantial and may add disincentive to participation.
The organization also considers retrospective assignment of patients to be a "major design flaw" and recommends patient assignment on a prospective basis. MGMA also suggest ACOs have the option to exclude two types of patients: (a) those expected to receive a significant percentage of healthcare from outside the geographic service area of the ACO and (b) those patients who, based on the most recent historical claims data, tend to receive a very high percentage of care from non-primary care physicians and look to specialists as "routine" care providers.
Read MGMA's comments on the proposed ACO rule in full.
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In a letter to Centers for Medicare and Medicaid Services, MGMA cited the following problems with the proposed ACO rule:
• The cost of ACO development and ongoing operation will be too high compared to the potential financial benefits.
• Financial benefits are not only too small, but also too uncertain.
• Regulatory risks under joint notices from CMS and the Office of the Inspector General, and the Federal Trade Commission and Department of Justice, are substantial and may add disincentive to participation.
The organization also considers retrospective assignment of patients to be a "major design flaw" and recommends patient assignment on a prospective basis. MGMA also suggest ACOs have the option to exclude two types of patients: (a) those expected to receive a significant percentage of healthcare from outside the geographic service area of the ACO and (b) those patients who, based on the most recent historical claims data, tend to receive a very high percentage of care from non-primary care physicians and look to specialists as "routine" care providers.
Read MGMA's comments on the proposed ACO rule in full.
Related Articles on ACOs:
5 Thoughts on ACOs from Healthcare Leaders
AHA Issues Response to Proposed ACO Antitrust Policy, Urges IRS to Offer Guidance
ACOs Inspire Doubts, Criticisms of "HMO Redux"