Physician leadership vital While many organizations — including TMA — support the ACO concept, reac- tion to the proposed rules appears over- whelmingly negative. TMA expressed strong opposition to a number of provisions in the rules, in- cluding the proposed ACO governance structure. The proposed rules require ACOs to have a mechanism for shared governance that provides all ACO par- ticipants with “appropriate proportional control” over the ACO’s decision-making processes.
“TMA is concerned that the ‘propor- tionate control’ language … may be mis- construed as referring to control propor- tionate to capital contributions, which fails to appropriately acknowledge the importance of physician leadership in the ACO and the physician contribution of sweat equity into the ACO,” Dr. Lock- hart wrote in those comments. TMA went even further in suggest-
ing CMS amend the rules to specifically require at least 51 percent of an ACO’s governing body be physicians elected by an ACO’s participating professionals. TMA also opposed the proposed “two-sided” payment structure that not only would reward physicians and other health care professionals with a share of any savings, but also would penalize them if the ACO incurred losses. Under that proposal, each ACO could choose a payment track for the first three-year agreement with CMS. Under Track 1, ACOs would share in savings during the first two years of the agree- ment and share in saving or losses dur- ing the third. Under Track 2, the ACOs would share in savings and losses during all three years of the agreement with Medicare. All subsequent agreement periods would require the ACOs to share in both sav- ings and losses.
In its comments, TMA contended
that introduction of shared losses fun- damentally alters the primary incentive system envisioned under the health re- form law. Although the law authorizes the use of payment models other than shared savings, the primary payment structure envisioned “was one designed to encourage participation in the MSSP
August 2011 TEXAS MEDICINE 59
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76