Mayo, Geisinger, Cleveland Clinic May Not Participate in ACOs

Officials at four health systems often cited as models for accountable care organizations have doubts that they will participate in the ACO program, citing problems with the proposed rules for ACOs, according to a report by the Congressional Quarterly.


Officials from Mayo Clinic, the Cleveland Clinic, Geisinger Health System and Intermountain Health praised the ACO concept but criticized the proposed implementation. Here are some of their comments.


Mayo Clinic: "Are we interested? Absolutely," said Patricia Simmons, the medical director of government relations at Mayo Clinic. "But is it feasible? There'd have to be substantial revisions for us to participate."

Cleveland Clinic: "It's clearly the right way to go and the journey is a good one. But it's a matter of recommending ways in which we think CMS can make the ACO model and its structure better," said Oliver Henkle, the chief government relations officer at the Cleveland Clinic. He said the clinic will send CMS a comment letter detailing a long list of barriers that need to be reconsidered.

Geisinger Health System: Since the system is involved in a CMS demonstration program, it would not be eligible to join an ACO until after it ends. But Thomas Graf, chairman of the Community Practice Service of Geisinger, said it's unclear whether Geisinger would want to join an ACO. While the concept ACOs is sound, "it's the regulations themselves that many organizations have a large number of concerns with," he said. "A lot of the detail-level work is problematic. It seems to be very prescriptive and restrictive with a fair amount of administrative and regulatory oversight."


Intermountain Health: "We're way past [the ACO concept]," said Brent James, the executive director for Intermountain Healthcare's Institute for Healthcare Delivery Research. "I look at the ACOs coming out as almost fluff and distraction on the side, not that it's not good but it's just that the mainstream is already moving out there on the front line [to other ideas]."


Here is a sampling of concerns about parts of the proposed ACO rules that the Congressional Quarterly gathered from the four institutions and other providers.

Financial risk. Many providers had expected the program to offer a way for institutions to get bonuses without having to face penalties.


Quality measures. ACOs will have to collect 65 quality measures, which very few institutions now do. Adding technology and training staff to track this information could be expensive.


Financial solvency requirements. Providers joining an ACO would have to meet financial solvency requirements that could be especially hard for small practices to meet.


Governance requirements. An ACO must be a certified legal entity recognized under state law. While ACO participants must control of three-fourths of the governing body, beneficiaries must be involved in oversight.


Baseline for improvements. The baseline from which providers must improve is set at the current expenses of the provider, which doesn't reward providers who have already lowered their costs.


Member assignment. Since assignment of patients is retrospective, providers won't know for certain which beneficiaries are in their ACO until a year after the program starts.


Start date too early. Many providers believe the start date of Jan. 1, 2012 is set too early. The final rule isn't expected to be released until August, giving ACO-planners four months to meet financial requirements, set up quality metrics and enroll. However, applicants that do not meet the Jan. 1 deadline will be able to apply the following year.


Some providers are already looking ahead to other opportunities expected to be developed CMS center for Medicare and Medicaid Innovation. Offerings may include capitated models, which might offer more benefits to efficiently run organizations than ACOs can offer.


Read the Congressional Quarterly report on ACOs.


Related articles on ACOs:

Not Ready to Form an ACO? Three Value-Based Alternative Models

ACOs Could be Stymied By Data Problems, NCQA Head Says

3 Key Deficiencies of ACOs From the Heritage Foundation


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