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AMA: Final ACO Rule Offers Promise to Improve Care Delivery

Final rule includes important improvements recommended by AMA

For immediate release:
Oct. 20, 2011

Statement Attributable to:
Peter W. Carmel, MD
President, American Medical Association

CMS Final Rule on ACOs

“We are pleased that the final rule on Medicare Accountable Care Organizations (ACOs) includes many of the important changes recommended by the AMA to allow all interested physicians to lead and participate in these new models of care.

“The AMA has stressed throughout this rule-making process that, if well-implemented, the ACO model offers promise to improve care coordination and quality while reducing costs. This final rule requires a full, in-depth review to ensure it maximizes those potential benefits for Medicare patients and physicians.

“After preliminary review, the AMA believes this final rule includes a number of positive changes. The AMA recommended that the risk and payment structure for potential ACOs should encourage participation by physicians in all practice sizes, and we are very pleased that this rule allows ACOs to share in every dollar of cost savings and includes an option that limits financial risk, which is important for many physician practices.

“As the cost of forming an ACO is high, physician practices will also benefit from the new advanced payment initiative created through the Centers for Medicare and Medicaid Innovation to provide financial assistance for physician-owned organizations.

“Other changes should also allow for greater physician participation in ACOs, including a rolling application process that allows more time for practices to prepare and removing the requirement that 50 percent of primary care physicians in an ACO must be ‘meaningful users’ of electronic health records.

“The AMA asked for ACOs to report on a lower number of quality measures that were most relevant to their patient populations and for removal of the measures associated with hospital-acquired conditions (HAC). The final rule reduces the number of required measures by half, including removal of the HAC measures, but the AMA would have preferred even greater flexibility on which measures practices are required to report.

FTC/DOJ Statement and OIG Interim Final Rule on ACOs

“The AMA is very pleased that the FTC and DOJ made changes to their antitrust statement on Medicare ACOs, including removing the requirement for mandatory review and clarifying that all collaborations among independent providers, including those that existed prior to March 23, 2010, are covered by the statement. These important changes will significantly lower the administrative burden and cost for potential ACOs to comply with the antitrust rules.

“While we are still reviewing the rule, the AMA is pleased that CMS and the OIG adopted our recommendations to expand the waivers of certain Medicare laws for ACOs. The agencies adopted the AMA recommendation that the waivers begin sooner so that they will apply during the process of planning Medicare ACOs. It is important that the agencies issued these new waivers as an interim final rule, as the AMA had recommended, which allows for greater flexibility.”

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Contact:

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

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