Dr. Stuart B. Black, chief of neurology and co-director of the Neuroscience Center at Baylor University Medical Center at Dallas, thought that the newly released rules have some significant and noteworthy changes which may ease many of the requirements to forming ACOs.
The new design for the final rules may make it more attractive for hospitals to consider organizing an ACO. This could put more pressure on staff physicians, including neurologists, to participate in the new health care models. While primary care physicians may only be able to participate in one ACO, it is possible that neurologists and other specialists who are in short supply would be able to belong to more than one ACO, Dr. Black said in an interview.
The rules for credentialing of ACOs may not be something that neurologists and other physicians are accustomed to. Dr. Black, who is chairman of the Texas Neurological Society Medical Economics Committee, emphasized that to maximize the opportunity for shared savings in an ACO, economic criteria will need to be evaluated even more carefully. He indicated that because ACOs are composed of groups of providers who work together to manage and coordinate the care of beneficiaries, cost effectiveness, as well as quality, becomes an integral element in the overall care of patients. If the cost of a physician is excessive relative to his or her peers while providing the same or similar services, this becomes a collective burden to all the ACO members. Dr. Black pointed out that in an ACO, physicians in a leadership position may need to impose economic credentialing criteria on their peers.
Simultaneously with the announcement of the final rule, several federal agencies issued additional guidance on how ACOs could steer clear of violating antitrust laws and other measures designed to keep medicine competitive.
The Department of Health and Human Services Office of Inspector General also issued an interim final rule on how the ACOs could stay within the antikickback rules.
In the proposed rule, ACOs were required to seek antitrust review from the Federal Trade Commission and the Department of Justice. The final rule lifts that requirement, and instead advises potential ACOs to seek review. Those two agencies issued a final policy statement outlining enforcement plans and indicating that voluntary reviews would likely take about 90 days.
The full text of the final rule is available at http://bit.ly/oXwIV3
The rules for ACO credentialing may not be something that neurologists and other physicians are accustomed to.
Source DR. BLACK