Hospital group and physicians looking at ACOs; Harvard to open primary care education center

Modern Healthcare: "In an Oct. 27 letter to the CMS, the Federal Trade Commission and HHS inspector general's office, the Federation of American Hospitals offered comments on accountable care organizations. … Of particular interest, the letter noted, is whether—and how—the government would establish a safe harbor so that qualifying ACOs can have a degree of certainty when dealing with commercial payers." An excerpt from the letter reads, "The absence of such a safe harbor will retard the spread and potential benefits of ACOs, both in Medicare and the commercial market. … First, most providers do not seek to organize themselves solely around participation in the Medicare program. Second, the effort required to build an ACO solely for a Medicare population may be cost prohibitive." It also argues that benefits of ACOs "should be shared and encouraged into the population as a whole" (Zigmond, 10/27).

AAFP News Now: The Medicare Shared Savings Program, established under the health overhaul law, requires the secretary of Health and Human Services to "establish a shared savings program that 'promotes accountability for a patient population and coordinates items and services under (Medicare) parts A and B.'" Although the legislation "includes language that defines participation, eligibility and reporting requirements, much of the fine print as to how ACO test programs will function under HHS will be left to the rulemaking discretion of the HHS secretary." American Academy of Family Physicians President Roland Goertz said the law allows physicians to play a significant role in determining ACO structure, and that "any successful ACO will have physicians at the top managing the organization and woven into the very fabric of the ACO's operations -- unless, of course, physicians are creating ACOs themselves, which certainly should be considered" (Porter, 10/27).

Meanwhile, The Boston Globe reports that the "Harvard Medical School has received a $30 million anonymous gift to create a major center to transform primary care medicine, a specialty that provides routine front-line care to millions of people but that many doctors consider unglamorous and underpaid." The center will "pay part of the salaries for 20 to 30 faculty, oversee expansion of the curriculum in primary care, and fund research and experiments to test new models of providing primary care." The Obama administration is counting on primary care doctors "to help treat more than 30 million newly insured patients and play a bigger role in coordinating their care," but the "number of medical students going into primary care has dropped over the past decade," in part due to lower wages for primary care doctors compared with specialists, exacerbated by attitudes in the medical community (Kowalczyk, 10/28).