CMS officials plan to release proposed regulations on accountable care organizations next week, with attribution of beneficiaries the final issue to work out, according to several sources who have been working with the agency.
The regulations are due before the end of the year, and CMS officials "want to get them out before the holiday, because everyone will be gone after that," says Brett Hickman, national leader of the Health Industries Strategy and Planning practice at PricewaterhouseCoopers.
"The last-minute issue is the attribution process," says Mr. Hickman, referring to the process of assigning beneficiaries to a particular primary care physician within an ACO. He said agency officials are trying to work out assignment of beneficiaries who have not seen a primary care physician for years or have been seeing multiple primary care physicians.
Focus will be on ACO capabilities
Mr. Hickman says the regulations would focus on ACO capabilities, setting up guidelines in four areas:
1. Governance and management structure.
2. Clinical disease management and population health.
3. Distribution of earnings.
4. Developing an infrastructure to manage costs, which will probably involve having some form of electronic medical records system.
Mr. Hickman adds that the FTC is prepared to give "fast-track approval" for antitrust waivers to ACOs that truly share risk enforcement. FTC officials' listening sessions with stakeholders in early October were "very telling" about the agency's willingness to work with legitimate ACOs, he says.
He predicts that 5-12 organizations starting ACOs are ready to meet antitrust requirements.
CMS is expected to request applications from prospective ACOs within several months, pending approval of the final regulations, and the ACO projects may begin as early as late 2011, Mr. Hickman says.
Find out more about PricewaterhouseCoopers.
Read more about regulations for ACOs:
- Federal Regulations Should Address Four Points of Concern for ACOs
- Federation of American Hospitals Objects to NCQA Draft Criteria for ACOs
- 10 Recommendations on ACO Regulations From Premier's Collaborative
The regulations are due before the end of the year, and CMS officials "want to get them out before the holiday, because everyone will be gone after that," says Brett Hickman, national leader of the Health Industries Strategy and Planning practice at PricewaterhouseCoopers.
"The last-minute issue is the attribution process," says Mr. Hickman, referring to the process of assigning beneficiaries to a particular primary care physician within an ACO. He said agency officials are trying to work out assignment of beneficiaries who have not seen a primary care physician for years or have been seeing multiple primary care physicians.
Focus will be on ACO capabilities
Mr. Hickman says the regulations would focus on ACO capabilities, setting up guidelines in four areas:
1. Governance and management structure.
2. Clinical disease management and population health.
3. Distribution of earnings.
4. Developing an infrastructure to manage costs, which will probably involve having some form of electronic medical records system.
Mr. Hickman adds that the FTC is prepared to give "fast-track approval" for antitrust waivers to ACOs that truly share risk enforcement. FTC officials' listening sessions with stakeholders in early October were "very telling" about the agency's willingness to work with legitimate ACOs, he says.
He predicts that 5-12 organizations starting ACOs are ready to meet antitrust requirements.
CMS is expected to request applications from prospective ACOs within several months, pending approval of the final regulations, and the ACO projects may begin as early as late 2011, Mr. Hickman says.
Find out more about PricewaterhouseCoopers.
Read more about regulations for ACOs:
- Federal Regulations Should Address Four Points of Concern for ACOs
- Federation of American Hospitals Objects to NCQA Draft Criteria for ACOs
- 10 Recommendations on ACO Regulations From Premier's Collaborative