Long-awaited federal rule for accountable care organizations outlines 'gains and risks' for doctors, hospitals

Health and Human Services Secretary Kathleen Sebelius and Centers for Medicare and Medicaid Services Administrator Donald Berwick announced the release of the proposed rule Thursday, offering insights into how the administration hopes to encourage doctors and hospitals to collaborate more closely to improve patient care.

Kaiser Health News: New ACO Rules Outline Gains And Risks For Doctors, Hospitals
Doctors and hospitals that join together under a new model of care could pocket as much as 60 percent of the money they save Medicare but could also face hefty penalties if they fall short under rules proposed Thursday by the Obama administration (Rau, Galewitz and Vaida, 3/31). Additional KHN coverage includes a video and transcript featuring KHN staff writer Jordan Rau explaining how the Obama administration envisions accountable care organizations and a resource page with detailed information about the rule, including the rule itself and a number of Department of Health and Human Services fact sheets.

The New York Times: Standards Set For Joint Ventures To Improve Health Care
The Obama administration proposed long-awaited regulations on Thursday encouraging doctors and hospitals to band together, coordinate care and cut costs (Pear, 4/1).

The Washington Post: Obama Administration Offers Rules For Delivering Care To Older Americans
The Obama administration proposed rules Thursday for using the influential Medicare program to spur a controversial form of managed care emerging around the country that nudges doctors and hospitals to save money by coordinating treatment for their patients (Goldstein, 3/31).

Los Angeles Times: Obama Administration Proposes Rules For Health Care Partnerships
The Obama administration proposed new regulations Thursday to encourage doctors and hospitals to collaborate more closely to improve patient care, a major goal of the sweeping health care law the president signed last year (Levey, 3/31).

USA Today: Federal Plan Would Streamline Medicare
Health and Human Services proposed new regulations Thursday that it hopes will reduce Medicare costs and improve care by focusing funds on prevention and quality, rather than the number of times a patient sees a doctor (Kennedy, 4/1).

PBS News Hour: Medicare Rules Will Guide Hospitals, Doctors Toward More Cooperation
The ACO concept isn't new. Well-regarded health systems such as Geisinger Health System in Pennsylvania work this way. But the health care reform law will ramp up the incentives for more providers to join together in ACOs by offering financial benefits through the Medicare system. Under the new rules, ACOs that can prove that they are improving patient care and saving money will get to keep a percentage of those savings (Weinerman, 3/31).

The Wall Street Journal: Rules Aim To Reshape Medical Practices 
A key part of the new federal health-care law took shape Thursday as the government outlined rules for how doctors and hospitals can organize into new businesses to reduce Medicare costs and improve care (Johnson, 4/1).

Politico: Reform Regulations Fire Up Health Debate
The Senate wrapped up its work Thursday without repealing the hated paperwork requirement of the health care law. Again. But the long-delayed accountable-care-organization regulation finally came out — providing details on a part of the law with the potential to thoroughly transform care delivery. Just about everyone in Washington who deals with health care policy is reading through the 429-page proposed rule on how to set up ACOs (Nather, 4/1).

The Associated Press: Obama Health Idea Could Mean Better Care, Saving
If things work out, medical providers would share in the savings. If the experiment fails, they're likely to get stuck with part of any additional costs. Sebelius said early estimates are that Medicare could save as much as $960 million over three years. That's not a whole lot for a $550-billion-a-year program, but officials say it's a start. The estimate was prepared by Medicare's office of the actuary, known for its independence. Eagerly awaited by the health care industry, the new approach was called for in President Barack Obama's health care overhaul (3/31).

National Journal: In ACO Proposal, Room For Changes, Hope
If all goes as planned, the providers in an ACO will collect a portion of the money saved as care becomes more efficient. Federal actuaries predict that Medicare could save as much as $960 million over the first three years. The quality of care is emphasized every step of the way. Embedded in the ACO concept are two key themes. One is that the nation's health care system has grown so disparate that patient care is being jeopardized and costs are out of control. The other is the notion that streamlining the process will lead to better-coordinated care and lower costs in the process (DoBias, 3/31).

Bloomberg: Antitrust Oversight Of Health-Care Networks Will Be Shared
The U.S. Federal Trade Commission and the Justice Department will conduct antitrust reviews of proposals to form networks under the new health care law, ending for now a debate over which agency would take the lead. The FTC and Justice Department will decide on a case-by- case basis which agency will investigate, much like they now determine merger reviews, Christine Varney, who heads the Justice Department's antitrust division, said in an interview today. "I don't anticipate there will be any problem in dividing this up," she said (Bliss, 3/31).

Modern Healthcare: Industry Groups Stress Need For ACO Flexibility
As the country's health care industry groups evaluate the 429-page proposed regulation on accountable care organizations that HHS released today, some are emphasizing the need for flexibility in this new model. The [American Medical Association] made recommendations to CMS on how to make it possible for physicians in all practice sizes and settings to successfully lead and participate in ACOs, including flexible requirements for ACO structure, transitional steps for ACO formation, increased access to loans and grants for small practices, easing of antitrust restrictions, and timely access to quality data,”Dr. Jeremy Lazarus, speaker of the American Medical Association House of Delegates, said in a statement. The American Hospital Association said it hopes the rule allows for flexibility in a way that builds on the strengths of local providers. There also should be accompanying policy changes that would remove barriers to clinical integration that make it difficult for caregivers to deliver the best care, the association said in a statement (Daly and Zigmond, 3/31).

Earlier, related Kaiser Health News coverage:  FAQ On ACOs: Accountable Care Organizations, Explained (Gold, 1/13).