McDermott Will & Emery recently released a detailed white paper entitled, “The Controversial Draft Medicare ACO Regulations: Analysis, Comments, and Recommended Action." McDermott health lawyers have prepared this publication to help make sense of the proposed ACO regulations, and provide specific action steps.
ACOs, which create incentives for health care providers to work together to treat individual patients across multiple care settings, are at the core of the federal health care reform legislation enacted last year. On April 7th, the Centers for Medicare and Medicaid Services (CMS) finally published 400+ pages of draft ACO regulations that many in the health care industry view as excessively burdensome and biased against providers. On May 17th, the Center for Medicare and Medicaid Innovation announced a parallel track ACO initiative called ‘Pioneer ACO’ that may have been intended to overcome such objections and stimulate interest in ACO participation.
“Reaction to the proposed rules issued by CMS to implement the Medicare Shared Savings Program ("MSSP") has reportedly been harsh and critical,” observed Gary Scott Davis, a partner at McDermott Will & Emery who focuses his practice on managed care, hospital-physician alignment and health system strategic transactions, restructurings and reorganizations. "While it remains to be seen how the Federal Government will ultimately implement ACOs, providers today are looking for much-needed guidance as they consider ACO participation,” added Davis. “Regardless of whether a hospital, health system, physician group or other provider presently intends to participate in the MSSP, understanding the regulations are important to any ACO formation, whether with Medicare or a private insurer. We believe that ultimately many of the concepts being vetted and developed – metrics and mechanics to measure and assess quality as a means for reimbursement -- will end up being incorporated into private market ACOs.”
Private sector efforts toward accountable care are well under way, and will continue whether or not the final regulations are implemented. “The private sector will not wait for the government to figure this out,” adds Davis. “There is a major paradigm shift already under way that is making the need for accountable care ever more urgent. And, because there are elements in the proposed regulations that provide important foundational concepts for achieving accountable care in the private sector, our white paper should prove uniquely valuable. This document should be particularly helpful to industry participants seeking to accomplish two critical goals of accountable care: tying quality to payment and capturing and using the critical data needed to get paid on this basis.”