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Berwick: ACO Rule Should Be Right Rather than Rushed

By Jane Norman, CQ HealthBeat Associate Editor

March 8, 2010 -- A long-awaited rule on accountable care organizations (ACOs) has been delayed because it's so important to get right, Centers for Medicare and Medicaid Services Administrator Donald M. Berwick told health insurers.

Berwick told members of America's Health Insurance Plans at a conference that the ACO rule will emerge "very soon," but he didn't specify a date. "You want to know where's the rule," he told the industry crowd. "Thank you for your patience. I understand how avid you all are to see that rule emerge."

On ACOs, Berwick stressed repeatedly the importance of not rushing. It's a "very important" rule, and it's complex, Berwick said. "The good news about the ACO rule is so many people care, all over the country, private stakeholders, public stakeholders," he said.

"Everyone wants to get this right,'' he said. "We have a choice: just set a deadline and hit it, or get the process right ... I do take the concerns seriously. I am as impatient as you."
Berwick had said Feb. 1 that the rule would be out within a month (see related story). He said at the time that the issues surrounding ACOs and their implementation are "tough."

The Department of Health and Human Services (HHS) sent the proposed regulation to the Office of Management and Budget (OMB) for review on Feb. 14, according to OMB records. Before a rule can be published in the Federal Register it must pass OMB muster.

ACOs were authorized for Medicare in the 2010 health care overhaul law (PL 111-148, PL 111-152). ACOs have grown up in the private market in recent years. As organized under Medicare, the new program would allow providers, including doctors and hospitals, to coordinate closely on the care of patients. The providers would then share in any savings. The program must be established by Jan. 1, 2012.

However, concerns have risen about how antitrust agencies, including the Federal Trade Commission and Department of Justice, would enforce antitrust laws in connection with ACOs and whether some arrangements might have the potential to increase prices or reduce competition in certain market areas. Physicians also have expressed concern about their roles in ACOs and want their medical decision-making to remain a guiding force for ACOs.

Other tricky questions are how patients will be assigned to ACOs, how they will be notified of these assignments, how small practices can join ACOs and how the quality of care in ACOs will be measured.

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