Four major federal enforcement laws, from the antitrust law to the anti-kickback law, will impede efforts by hospitals and other providers to create accountable care organizations, the AHA stated in a letter to CMS, the Federal Trade Commission and the HHS Inspector General.
The Sept. 27 letter was submitted in advance of an Oct. 5 workshop in Baltimore, in which officials from the three agencies will gather feedback on possible legal barriers to forming ACOs.
In its letter, the AHA referred to a variety of documents it has produced commenting on how each law impedes clinical integration and other efforts similar to ACOs. Here is what the three-page letter stated about each category of law.
1. Antitrust laws. Although the FTC has issued some information on antitrust enforcement, there is still no "user-friendly, officially backed guidance that clearly explains to caregivers what issues they must resolve to embark on a clinical integration program without violating the antitrust laws."
2. Physician self-referral law. Existing self-referral regulations "have become a tight web of confusing and changing requirements that place hospitals at risk for serious sanctions based on inadvertent or procedural violations." The law assumes physicians will be paid for "hours worked," but clinical integration involves "compensation linked to the achievement of results or use of clinical protocols or best practices."
3. Civil monetary penalty law. Health reform is about encouraging use of best practices and clinical protocols, but "using incentives to reward physicians for following best practices and protocols can be penalized under current enforcement of the CMP law." The statute is "a vestige of concerns in the 1980s that Medicare patients might not receive the same level of services as other patients after the prospective payment system was implemented."
4. Anti-kickback law. This law "has been stretched to cover any financial relationship between a hospital and physician." As a result, "rewards for a physician following best practices or evidence-based protocols could be construed as violating the statute."
Read the AHA letter on ACOs (pdf).
Read more on ACOs:
-Details on October Meeting About Legal Issues For ACOs Provided by Federal Enforcement Agencies
-ACO Panel to Discuss Competition Issues in Washington, D.C.
-The Impact of Healthcare Reform on Hospital Consolidation
The Sept. 27 letter was submitted in advance of an Oct. 5 workshop in Baltimore, in which officials from the three agencies will gather feedback on possible legal barriers to forming ACOs.
In its letter, the AHA referred to a variety of documents it has produced commenting on how each law impedes clinical integration and other efforts similar to ACOs. Here is what the three-page letter stated about each category of law.
1. Antitrust laws. Although the FTC has issued some information on antitrust enforcement, there is still no "user-friendly, officially backed guidance that clearly explains to caregivers what issues they must resolve to embark on a clinical integration program without violating the antitrust laws."
2. Physician self-referral law. Existing self-referral regulations "have become a tight web of confusing and changing requirements that place hospitals at risk for serious sanctions based on inadvertent or procedural violations." The law assumes physicians will be paid for "hours worked," but clinical integration involves "compensation linked to the achievement of results or use of clinical protocols or best practices."
3. Civil monetary penalty law. Health reform is about encouraging use of best practices and clinical protocols, but "using incentives to reward physicians for following best practices and protocols can be penalized under current enforcement of the CMP law." The statute is "a vestige of concerns in the 1980s that Medicare patients might not receive the same level of services as other patients after the prospective payment system was implemented."
4. Anti-kickback law. This law "has been stretched to cover any financial relationship between a hospital and physician." As a result, "rewards for a physician following best practices or evidence-based protocols could be construed as violating the statute."
Read the AHA letter on ACOs (pdf).
Read more on ACOs:
-Details on October Meeting About Legal Issues For ACOs Provided by Federal Enforcement Agencies
-ACO Panel to Discuss Competition Issues in Washington, D.C.
-The Impact of Healthcare Reform on Hospital Consolidation