In the year since the passage of the Affordable Care Act, Medicare's Accountable Care Organization program, or partnerships between providers designed to improve cost and quality in exchange for shared savings, has been one of the most-talked about components of the bill, especially within the industry. The fever pitch to join an ACO has even been parodied on YouTube, a telltale modern sign of the idea's popularity and reach.

After months of waiting—and with the Jan. 1, 2012, start of the ACO program looming, CMS finally released the 429-page proposed ACO rule last week. Among the big takeaways: CMS estimates that 75 to 150 ACOs will be formed, serving between 1.5 million to 4 million Medicare beneficiaries over the first three years of the program. Simultaneously, the FTC and DOJ released a proposed statement on antitrust enforcement policy as it relates to ACOs.

All this week, I've been surveying reaction to the rules, and the consensus seems to be that there were no major surprises in the rule that weren't apparent from reading the relevant portions of the ACA last year. Still, there are plenty of differing opinions out there to digest, and I've compiled a few of them that caught my notice:

  • In an interview with Health Leaders, Paul Keckley, executive director of the Deloitte Center for Health Solutions, said the main idea emanating from the guidelines is the promotion of physician-hospital alignment. "…You step back and see they are compelled by the vision of integrated systems," Keckley said. "That to me is the big cake here."
  • Over at The Health Care Blog, Vince Kuraitis, principal and founder of Better Health Technologies, concluded that the rule was "surprisingly aggressive and well-reasoned." Kuraitis called the Antitrust Enforcement Policy notice a sign that "concerns over maintaining competition and avoiding antitrust are being taken seriously." Kuraitis also had words of caution for organizations thinking of applying that may not be entirely ready to participate. "The bar has been set high…very high. Tire kickers need not apply."
  • Paul Levy, former CEO of Beth Israel Deaconess Medical Center, and author of the now Not Running a Hospital blog (formerly Running a Hospital), took issue with the fact that providers cannot require beneficiaries to obtain services from other providers. "How can you be held accountable, as a provider group, if you cannot control the management of care of your patients?" Levy wrote.
  • Jeremy Lazarus, M.D., speaker of the AMA House of Delegates, told American Medical News that all physicians who wish to participate should have the opportunity to do so. "ACOs offer great promise for improving care coordination and quality while reducing cost, but only if all physicians who wish to are able to lead and participate in them," Lazarus said. That will certainly be an issue; as I wrote earlier this week, some observers believe not all ACOs will have the capacity to absorb all interested parties.
  • And finally, reported that the legislation poses a challenge for IT vendors who will need to create systems that can distribute shared savings and share data among providers.

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