Health care orgs. balk at rules in overhaulby Elizabeth Stawicki, Minnesota Public Radio
St. Paul, Minn. — Clinics in Minnesota and nationwide are impatient for revisions of key regulations in the health care overhaul.
Most major US clinics are balking at the rules proposed for Accountable Care Organizations.
Medicare officials have listened to the complaints, but the agency must balance the needs of patients as well as clinics, said Dr. Don Berwick, administrator of the Centers for Medicare & Medicaid Services.
Currently, the government and insurers largely pay hospitals and doctors for each patient visit or procedure. But supporters of the health care overhaul say that kind of payment system drives up the nation's health care costs by giving providers incentive to perform more tests and procedures than may be necessary.
The Medicare Shared Savings Program is a program to encourage medical centers to form Accountable Care Organizations that reshape the delivery of medical care and represent one of the major legs of the health care overhaul.
ACOs would give health centers a powerful financial incentive to improve care and reduce costs. Payments to hospitals would be given in lump sums for group of patients, such as for those with heart disease, for example. Should a patient's health improve and not require a great deal of expensive care, the clinic would keep the savings. Should a patient require more care, doctors and clinics are on the hook for any excess cost.
Many health systems embraced the idea.
But when the federal government proposed more than 400 pages of regulations, the clinics best in a position to form ACOs objected.
The American Medical Group Association, which represents the multi-practice health systems best suited to become ACOs, found in a survey that 93 percent would not enroll as an ACO if the proposed rules remained.
Berwick received 1,200 responses to the proposed regulations. He said his office needs to weigh medical center concerns with those of Medicare patients and ensure that clinics don't cut corners to avoid financial losses.
"One of the hearts of the Medicare shared savings program idea is to share savings with the organizations that really do take a strong interest in coordinating care," Berwick said. "Beneficiaries would be concerned that we're actually going to be watching quality so that there's no skimping."
Berwick declined to disclose the contents of the final rule but said his office was crafting one that would reflect input from consumers to physicians to hospitals to urban and rural areas.
However, time is running short, said John Smylie, chief operating officer of Duluth-based Essentia Health Care. He said if the final regulations fail to streamline some of the rules it'll be tough for centers to make the January deadline to apply for the program.
"It is hard to gear up quickly with these programs," Smylie said.
Berwick said his office intends to hold fast to the Jan. 1 deadline, or stay as close to that date as possible.
- Morning Edition, 08/19/2011, 7:25 a.m.