Majority of ACO prototype testers have serious reservations

The new proposed rules for accountable care organizations (ACOs) haven’t been well-received, to say the least. All 10 of the clinics that participated in the prototype program, and 93% of American Medical Group Association (AMGA) members, said they would not participate in ACOs under the proposed rules.

In a May 12 letter to Donald Berwick, MD, administrator of the Centers for Medicare and Medicaid Services (CMS), the multispecialty groups that participated in the Physician Group Practice demonstration program wrote that they shared “serious reservations” about the shared savings program. They noted that the proposed rules included a shared risk component that the demonstration program lacked, as well as savings thresholds and minimum savings rates that would be challenging for smaller ACOs.

The proposed regulations include a large number of new quality metrics that would go into effect in the first year of an ACO’s contract. The clinics estimated that “it costs about $30,000 just to program a single new quality metric,” and that the cost for the 60 new ones in the proposed rules would be about $2 million for each organization.

Calling the proposed rule “overly prescriptive, operationally burdensome” and the incentives “too difficult to achieve,” AMGA’s letter to Berwick on May 11 expressed concern about many of the same issues as clinics. Fearing “draconian cuts across the provider spectrum” if ACOs are not successful, the AMGA letter urged CMS to develop a “regulatory framework for a viable ACO program” that will “create the incentive for providers to integrate, invest in technology and teams, and coordinate care.”

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