TMA House of Delegates adopts ACO policy
Accountable care organizations (ACO) must be physician led and governed in a manner that allows physicians to retain independent medical judgment, accord- ing to a new policy the Texas Medical Association House of Delegates adopted in May.
The new policy was recommended by
TMA’s Ad Hoc Committee on Account- able Care Organizations following nearly a year of study of the health care deliv- ery model that is gaining support among policy consultants and state and national lawmakers. The ad hoc committee’s report also suggested that physicians must receive guidance, tools, and education about ACOs to prepare them to make good de- cisions about whether to participate in these entities. Then-TMA President Susan Rudd Bai-
ley, MD, appointed the ad hoc commit- tee in 2010 on the recommendation of the Council of Socioeconomics. Council Chair Christopher Crow, MD, of Plano says that panel felt it was important to “get ahead of the storm and have some guiding principles in place” as formation of ACOs became more prevalent. Tyler anesthesiologist Asa Lockhart, MD, who chairs the ad hoc committee, says the panel’s charge was to look at the emerging delivery system and de- velop a TMA response. “ACOs have the potential to improve medical care and deliver it — if it’s done right — at a lower cost,” he said. “But physicians have to be front and center in that mission.” In its report,
Christopher Crow, MD
the ad hoc com- mittee particularly stressed the impor- tance of ACO gover- nance. “ACOs must be
physician-led and encourage an environ- ment of collaboration and professional- ism among physicians and other health care team members,” the ad hoc com- mittee wrote. “This ensures that health care delivered under the ACO model is patient-centric and that a physician’s medical decisions are not based on com- mercial interests but rather on profes- sional medical judgment that puts pa- tients’ interests first.”
The ad hoc committee also concluded
that ACOs must be operationally struc- tured and governed by an appropriate number of physicians, rather than lay entities.
Clinical decisions must be made by the physician or physician-controlled entities in an environment where they are free to exercise independent medical judgment free from commercial influ- ence, the panel added. Other policy recommendations the House of Delegates adopted include:
• ACO participation by physicians should be voluntary unless a physi- cian is a member of a preexisting phy- sician group that elects to participate.
• ACO participation by patients should be voluntary.
• Where a hospital is part of an ACO, the ACO governing board should be separate and independent from the hospital governing board.
• Physicians participating in ACOs should be afforded whistleblower protections if the ACO acts in a way contrary to the patient’s best interests.
• ACOs must not impose marketplace limiting agreements, such as cov- enants not to compete or exclusivity provisions, on physicians or physician practices.
Dr. Lockhart says it is important that
physicians begin to educate themselves about ACOs now so that they can make informed decisions about whether to participate.
CBO predicts 29-percent cut in Medicare payments
Unless Congress acts by year’s end, phy- sicians likely will see their Medicare payments slashed by 29.4 percent in January, according to a report released in June by the Congressional Budget Of- fice (CBO). The CBO report says the cut will
result from the Medicare Sustainable Growth Rate formula (SGR), but U.S. Center for Medicare & Medicaid Ser- vices (CMS) actuaries have called such a large reduction in physician Medicare payments “implausible.” “That large reduction called for un- der current law follows several years of legislative action to either maintain or increase physician payment rates under the Medicare program when those rates were otherwise scheduled to decrease under the provisions of law known as Medicare’s Sustainable Growth Rate (SGR) mechanism,” the report said. “Such legislative actions have overridden the SGR.” The Texas Medical Association has
urged Congress to enact a permanent SGR fix that would stop cuts to physi- cian Medicare payments, but Congress instead has enacted a series of tempo- rary fixes to stave off the cuts and pro- vide minimal increases in payment rates. In its report, the CBO outlined poten- tial options for fixing the SGR, including an annual 2-percent increase through 2021 after resetting the SGR or forgiv- ing all over-target spending that cumula- tively accrued up to Dec. 31, 2010. That option would cost $388.5 billion. Another option would use the same
resetting formula and then link updates to the Medicare Economic Index. That option has been projected to cost $358.1 billion from 2012 through 2021. n
Ken Ortolon is the senior editor of Texas Medicine. You can reach him by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at
ken.ortolon@texmed.org.
August 2011 TEXAS MEDICINE 61
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