KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Health Care Providers Approve Of ACO Rule Revisions

The regulations, which were released Thursday, relaxed requirements for doctors and hospitals to participate in the program. Some insurers and employers, however, complained that the changes will increase the chances that providers will consolidate, which could reduce competition and drive up costs.

Kaiser Health News: HHS Releases Final Regulations For ACOs
Kaiser Health News staff writers Phil Galewitz and Jenny Gold report: "The Obama administration on Thursday bowed to health industry concerns about its plans for Medicare accountable care organizations, making it easier for doctors and hospitals to participate in the program designed to lower medical costs. Physician and hospital groups applauded the changes in the final ACO rule announced by officials at the Centers for Medicare and Medicaid Services. The administration is betting the new design will entice scores of health care providers to form into an untested health care model next year" (Galewitz and Gold, 10/20).

The Washington Post: Obama Administration Revises Medicare Rules For Coordinated Care
The move was greeted with jubilation by groups representing doctors and hospitals. But organizations for insurers and employers complained that the administration's concessions increased the likelihood that providers will consolidate, reducing competition and driving up prices (Aizenman, 10/20).

Los Angeles Times: Changes Seek To Save Key Aspect Of Health Care Law
The Obama administration moved Thursday to salvage a much-touted initiative in the new health care law aimed at controlling costs, revising regulations to encourage doctors, clinics and hospitals to take greater responsibility for improving patients' care. The new rules will reward health care providers who form partnerships to reduce the cost of caring for Americans on Medicare while also boosting quality, two goals of the sweeping overhaul the president signed last year (Levey, 10/20).

Politico: Health Cost-Cutting Program To Get Do-Over From HHS
The Obama administration needed final rules for its most ambitious health care payment reform program that could win over skeptical providers — and initial industry reaction suggests it just may have pulled that off. The final rule, released Thursday, lays the groundwork for creating accountable care organizations in Medicare, networks of doctors and hospitals that are rewarded for delivering care at lower cost by keeping a share of savings they produce (Feder and Millman, 10/20).

The Wall Street Journal: Rules Loosened For New Medicare Program
The program — a part of the 2010 health overhaul designed to cut costs — provides incentives for groups of medical professionals to provide every aspect of a patient's care, including preventive medicine and treatment after a patient leaves the hospital. If the coordination in the "accountable-care organizations" reduces costs, Medicare will reward the providers with a portion of the savings (Radnofsky, 10/21).

Reuters: Medicare Relaxes Rules For Coordinated Care
Health regulators on Thursday relaxed rules to make it easier for hospitals and doctors to receive financial incentives if they work together to coordinate patient care. The so-called Accountable Care Organizations (ACOs) are an experimental part of President Barack Obama's health care overhaul, meant to improve the quality of care while lowering costs in Medicare, the federal insurance program for the elderly and disabled. Officials from the Centers for Medicare and Medicaid Services (CMS) said they expect the program to save Medicare up to $940 million over the next four years (10/20).

Modern Healthcare: Self-Referral, Anti-Kickback Waivers Promised
Federal laws barring certain anti-competitive practices were waived for health care providers that participate in the accountable care organization program, under regulations issued today. Specifically, various provisions of the physician self-referral law, the federal anti-kickback statute, and the certain civil monetary penalties law will not apply to providers in the Shared Savings Program or to ACO providers in the Center for Medicare & Medicaid Innovation's Advance Payment Model. Regulators chose to waive the laws that aim to prevent provider fraud, underutilization, overutilization and other problems because providers responding to the proposed ACO rules warned the laws may prevent the creation of such entities, according to today's rule (Daly, 10/20).

CQ HealthBeat: Hospitals Win: No Mandatory Antitrust Review For Big ACOs
Federal antitrust officials clearly paid attention to the complaints of hospitals in shaping a final policy statement on accountable care organizations that was released on Thursday. Hospitals, which will be the dominant players in most ACOs, had expressed major concerns in comments to the Department of Justice and the Federal Trade Commission about a proposal to require a mandatory antitrust review for the largest ACOs before they could become part of the Medicare program. That would be expensive and burdensome, hospital officials said (Norman, 10/20).

CQ HealthBeat: Providers Scan ACO Rule And Praise Progress, But Want To Keep Reading
Reaction to the final rule for accountable care organizations that Medicare officials issued on Thursday was cautiously optimistic. But health care providers warned that they were continuing to study the fine print of the 696-page document, and no one was ready to declare the revised regulation a home run. Health policy stakeholders were not fully on board with the new version because of their experience with the proposed rule was so unpopular that some of the prime ACO candidates said they doubted they could take part unless major changes were made. The idea behind ACOs is to organize collaborative, team-based care among providers, with the goals of lower costs and higher quality (Norman, 10/20).

National Journal: Obama Administration Concedes A Bit On Health Reform Regs
The Health and Human Services Department has made significant concessions on its controversial rules governing accountable care organizations – the new hospital structures meant to help improve the U.S. health care system. They make changes to coax doctors and hospitals to come on board, including allowing some of the new ACOs to operate without financial risk and also eliminating a confusing and unpopular provision that would have kept patients and doctors in the dark about who was actually included in an ACO. They also slashed the number of quality measures doctors and hospitals will have to report on from 65 to 33 (McCarthy, 10/20).

The Hill: New Coordination Program In Health Care Law Pleases Hospitals, Irks Employers And Insurers
Hospitals rejoiced and insurers worried about industry consolidation after the Obama administration unveiled a key program of his health care reform law that aims to promote coordination among health care providers. Long-awaited regulations published Thursday seek to improve patient outcomes and make the nation's fractured health care system more efficient by rewarding efforts to coordinate care. The Accountable Care Organization program is the law's main mechanism for transforming the health care system, and its success is seen as vital for building support for a health care law that has been criticized for doing little to control costs (Pecquet, 10/20).

Bloomberg: Health Rules Prod U.S. Hospitals To Form Networks For Care To Trim Costs
Hospital chains such as Community Health Systems Inc. (CYH) may get as much as $1.9 billion in bonuses by forming joint ventures to improve care and cut medical costs under regulations released by the Obama administration. The U.S. Department of Health and Human Services issued final rules today for so-called accountable care organizations for the elderly and disabled, a centerpiece of the health-care law designed to save as much as $940 million in three years. Savings would be shared between providers and the government (Eisenberg and Wayne, 10/20).

The Associated Press: Government Sets Final Rules On Care Organizations
The federal government laid out on Thursday final rules for a new program that aims to improve patient care by getting doctors, hospitals and other care providers to work together more. Health care providers will be able to start forming accountable care organizations in 2012 to coordinate care, share records, and cut down on duplicative tests and medical errors. Providers will have to make a three-year commitment to care for a group of at least 5,000 Medicare patients if they form these organizations known as ACOs (10/20).

Minnesota Public Radio: Rules Released On How Federal Health Care Law Will Work
Mayo Clinic, which also objected to the proposed rules earlier this year released a statement that said it looked forward to doing a thorough analysis of the regulations. ... Minnesota's largest doctor's group, the Minnesota Medical Association said the rules appear less burdensome and less rigid. MMA CEO Dr. Bob Meiches of Minneapolis said the new rules might make ACOs more attractive to physicians, but it's still early to tell (Stawicki, 10/20). 

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