Medical Lobbies Make Final Pitches For Reshaping ACO Rule

Contract for longer periods and realize the money-saving potential of imaging technology by excluding spending on preventive care, say makers of the cutting-edge gear.

Don’t back away from the accountable care organization (ACO) program; it’s critical to a sustainable Medicare program, the senior lobby AARP says.

Exclude certain types of Medicare payments to teaching hospitals in totaling up how much money ACOs spend on care, the Association of American Medical Colleges urges.

Comments on the proposed Medicare rule for fostering team-based care through ACOs came in fast and furious from all quarters at the close of the comment period, which was midnight on June 6. That’s a reflection of the potential impact ACOs have on reshaping health care delivery. Many lobbies want the Centers for Medicare and Medicaid Services (CMS) to significantly alter its proposed ACO regulation before making it final later this year.

The premise of Medicare ACOs is that well-organized, team-based care can reduce spending by the entitlement program. The way to motivate the health system to deliver those savings is to give providers a share of how much they can keep spending on Medicare patients below targets agreed to with CMS.

Imaging group lobbies
The Medical Imaging and Technology Alliance (MITA), which represents the makers of MRI, CT, PET and other state-of-the art imaging equipment, urged CMS to extend contracts with ACOs beyond three years, the period called for in the proposed rule for the ACO Medicare Shared Savings Program (MSSP).

“The short, three-year time frame for agreements under the MNSSP could incentivize ACOs to implement measures that achieve immediate savings for Medicare and the ACO, but would impose costs on beneficiaries and Medicare in later years,” an MITA comment letter said.

“For example, an ACO might seek to reduce expenditures during the MSSP contract period by restricting use of appropriate imaging services. This approach would be costly in the long term, though, because beneficiaries would suffer as their physicians try to diagnose and treat them without adequate clinical information. Beneficiaries could be subjected to delayed diagnosis or inappropriate care, which ultimately would offset any savings achieved,” MITA added. A focus on short-term savings also could dissuade companies from investing in innovative imaging equipment, the group said.

MITA said CMS should not count spending on preventive care in calculating whether an ACO meets its target. “Although increased compliance with appropriate use of preventive care could reduce later costs of care by preventing illness or allowing treatment at earlier, less complicated states of disease, it almost certainly will increase costs during the three-year window of the MSSP. Thus, ACOs would have a perverse incentive not to increase the use of preventive services.”

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