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AMA: Key Modifications Needed So Physicians Can Lead, Participate in ACOs

For immediate release:
May 26, 2011

WASHINGTON – The American Medical Association (AMA) today submitted comments to the Federal Trade Commission (FTC) and Department of Justice (DOJ) on their proposed policy regarding antitrust enforcement of Accountable Care Organizations (ACOs). The AMA called on the FTC and DOJ to make strategic changes to their proposed policy so physicians in all practice sizes can develop, lead and actively participate in ACOs.

“The FTC and DOJ antitrust policy is a critical piece of the proposed rules governing ACOs, and it must lay the groundwork for the success of these new models of care,” said AMA President Cecil B. Wilson, M.D. “Forming an ACO requires significant resources for physicians, and may include major changes to their practice. If physicians cannot see a clear path to forming an ACO, these models will not achieve their full potential to increase care coordination and promote cost savings.”

The AMA has stated that existing antitrust rules can make becoming part of an ACO difficult for physicians, especially those in small practices. A full 78 percent of office-based physicians in the United States work in practices with nine physicians or less, and a majority of those are in practices of 1 to 4. Under existing antitrust enforcement policies, these physician practices are effectively prohibited from jointly contracting with private payers around necessary care improvement and coordination efforts.

“While we appreciate this first step in proposing necessary changes to antitrust rules, further clarification and modifications are necessary to ensure physicians in all practice sizes can form an ACO,” said Dr. Wilson. “As proposed, the FTC and DOJ policy on ACOs simply does not go far enough to level the playing field, leaving small physician practices at a disadvantage compared to hospitals and dominant insurance companies.”

The AMA voiced support for the goals of proposed policies including the rule of reason analysis, the establishment of a safety zone and a 90-day expedited review process for ACOs that require an FTC/DOJ approval, but prescribed specific modifications to allow all physicians who wish to do so to successfully form ACOs, including raising the safety zone threshold from 30 to 40 percent and the mandatory review threshold from 50 to 60 percent. The AMA also recommends permitting ACOs to exceed these thresholds if they face competition in their markets. 

The AMA will also submit comments to CMS regarding their proposed rule governing ACOs.

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Contact:

Heather Lasher Todd
AMA Media Relations
202-789-7430
Heather.Lasher.Todd@ama-assn.org

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