The four biggest primary care physician organizations issued a joint document last month that contained what they believe are important principles to guide the development of accountable care organizations.
The 21 principles were developed and issued by the American Academy of Pediatrics, American Academy of Family Physicians, the American College of Physicians, and the American Osteopathic Association. According to the groups, the principles were submitted to the Centers for Medicare and Medicaid Services for consideration as guiding principles for ACO demonstration projects.
The organizations also are hoping to see the guidelines adopted more widely. “The AAP urges adoption of these principles by governments, payers, providers and all others who are involved in the health, well-being and success of America's children and their families,” Dr. O. Marion Burton, president of the AAP, said in a statement.
ACOs are being considered as the underpinning of health reform, changing how health care is delivered and financed. The Affordable Care Act calls for Medicare beneficiaries to be assigned to ACOs, which has spurred some debate.
The CMS is charged with developing regulations on how ACOs will be structured and how Medicare and Medicaid will pay providers that participate. The agency, along with the Federal Trade Commission and the Office of Inspector General of the Department of Health and Human Services, held a public meeting on ACOs on Oct. 5 to gather input.
And in mid-November, the CMS issued a request for information on ACOs. All comments were due by Dec. 3. The agency is expected to issue regulations later, perhaps by early 2011.
The agency has been looking at a risk-sharing payment methodology that would reward providers for improved quality and lower costs.
The Joint Principles for Accountable Care Organizations issued by the primary care groups outlines a number of principles that should guide that payment system. For instance, incentives should “adequately reflect the relative contributions of participating physicians,” and practices that participate in ACOs and achieve recognition as medical homes “should receive additional financial incentives,” according to the Joint Principles.
The Medicare Payment Advisory Commission (MedPAC) has backed the ACO concept and the notion of shared savings as a means for eliminating inefficiencies.
In comments submitted to the CMS on Nov. 22, MedPAC Chairman Glenn Hackbarth wrote, “If structured carefully, a shared savings program for ACOs could present an opportunity to correct some of the undesirable incentives inherent in fee-for-service payment and reward providers who are doing their part to control costs and improve quality.”
Shared savings also could “help beneficiaries receive more coordinated care and become more engaged with their care management, particularly if beneficiaries are informed when they are assigned to ACOs,” he wrote.