Mayo Says No to ACOs

Not to be repetitive, but the latest stake to be driven into the heart of the ACO Proposed Rule comes from the hand of the Mayo Clinic:

The prestigious Rochester clinic is raising questions about accountable care organizations, or ACOs, which are supposed to be updated — and better — versions of health maintenance organizations. Approved as part of the 2010 health care law, they are designed to improve care and cuts costs by over half a billion dollars a year.

 But Mayo says the proposed regulations from the federal Centers for Medicare and Medicaid Services (CMS) conflict with the way it runs its Medicare operations, which treat about 400,000 patients a year.



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Cleveland Clinic Bashes ACOs

The drum beat is deafening.  Dr. Delos Cosgrove, CEO of the Cleveland Clinic, one of the delivery models upon which the ACO concept was purportedly based, blasts the ACO Proposed Rule in a blunt but important letter to Don Berwick. 

Is CMS listening, we wonder?  No way they keep riding this broken horse.  The concept is good, the execution is flawed, and CMS must go back to the drawing board to a certain extent if ACOs are to survive as a viable reform model.

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GOP Senators Pen Letter to HHS

Yesterday seven GOP Senate Finance Committee members signed a letter to Sec. Sebelius stating what seems to be the common refrain on the Proposed Rule for ACOs – that, while well-intended, the Rule fails in its objective to incent providers to organize themselves into the promising-yet-expensive ACO model.  Best quote of the letter – “Therefore we respectfully ask that you withdraw this proposed rule and re-engage experienced stakeholders to craft a new rule the fulfills the promise of ACOs.”

Here’s hoping HHS reads this carefully. 

Letter from GOP to HHS

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Anesthesia in ACOs

Somnia Anesthesia writes about the role large anesthesia groups can (and must) play in the collaboration and coordination that will achieve real savings for accountable care organizations and the healthcare system as a whole.  We wholeheartedly agree.

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Becker on ACOs

Scott Becker of Becker’s Hospital Review lobs in some observations on ACOs – interesting stuff.  We would agree with most of his thoughts, especially #6 – the risk of ACO’s becoming a central model (or the precursor to one) in some future integrated delivery system is too great for providers to ignore.  The costs of formation may be high, and the bugs in the program have yet to be worked out, but the concepts that are driving the push to ACOs are here to stay.

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ACOs and Private Payors

Anthem Blue Cross Blue Shield in Indiana is interested in the ACO concept and has initiated discussions with local hospital systems.  Will other private payors show similar interest in expanding the scope of the Shared Savings Program to the private health insurance market?

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Morning Links

Not a link, but I just got back from a health law conference where every speaker, to a person, thought that ACOs were dead in the water as the Proposed Rules stand today.  It boggles the mind as to why CMS went to this much trouble to write Rules that ultimately incentivized no one to participate, when only large-scale participation would bend the cost curve and affect systemic improvement in care.

In related news, the George Washington University School of Public Health and Health Services released a white paper on the exclusion of Federally Qualified Health Centers from forming ACOs or counting their patients – for whom they are reimbursed globally, instead of on a fee for service basis – for attribution to ACOs.

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