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American Hospital Association Calls for Revamp of the ACO Programs




by:
Leslie J. Levinson
Edwards Wildman Palmer LLP - New York Office

Michaela ("Kayla") Tabela
Edwards Wildman Palmer LLP - Boston Office

 
April 28, 2014

Previously published on April 2014

On April 17, 2014, the American Hospital Association (“AHA”) published a letter to the Centers for Medicare & Medicaid Services (“CMS”) criticizing the current Pioneer Accountable Care Organization (“ACO”) Model and Medicare Shared Savings Program (“MSSP”).

In the letter, the AHA states that both programs “place too much risk and burden on providers with too little opportunity for reward in the form of shared savings” and sets forth a series of recommendations for improving the programs, including:

  • extending the Track 1 agreement period;
  • creating more achievable thresholds in the early years of the agreement;
  • allowing Medicare beneficiaries to “opt in” to ACO programs; and
  • simplifying and aligning quality measures.

The AHA also recommends developing different paths for provider participation, such as partial capitation for certain services (e.g., Medicare Part B), partial capitation for certain services (e.g., for patients with multiple chronic conditions), and full capitation for those providers that are willing and able to take on such risk.



 

The views expressed in this document are solely the views of the author and not Martindale-Hubbell. This document is intended for informational purposes only and is not legal advice or a substitute for consultation with a licensed legal professional in a particular case or circumstance.
 

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Author
 
Leslie J. Levinson
Michaela ("Kayla") Tabela
Practice Area
 
Health Care
 
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