New Ways to Deliver Care: The Center for Medicare and Medicaid Innovation promises cost-cutting ideas

“We don’t know what the long-term savings are going to be or if this will truly enhance the quality of care, Dr. Batra said “For our specialty, we have to be proactive and make sure we are there at the table having our voice heard; otherwise, somebody else will make the decisions for us.”

Input from Medical Societies

Medical societies are working to make sure their concerns are taken into account. In December 2010, 17 medical specialty societies, including the American Academy of Otolaryngology-Head and Neck Surgery, sent a letter to CMS outlining several concerns about the Medicare Shared Savings/ACO program created under the health reform law and ways the agency could best address them. The AMA sent a similar letter.

An ACO is an organization of health care providers that agrees to be accountable for the quality, cost and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program. Organizations that meet quality performance standards will be eligible to receive a share of the savings if the actual per capita expenditures of their assigned Medicare beneficiaries are a sufficient percentage below a benchmark amount.

Among other issues, both letters express concern that the participation of small, independent practices in ACOs could run them afoul of the federal antitrust, physician self-referral and anti-kickback statutes. The societies call for safe harbors and waivers so that practices can work collaboratively with others. “Currently, all of these laws and associated guidelines favor hospital-based systems with employed physicians,” the AMA letter states. “Yet the best way to preserve opportunities for appropriate competition in health care and choice for patients is to enable physicians to form ACOs in ways that enable them to continue practicing independently of hospitals and large health systems.”

In his December speech, Dr. Gilfillan emphasized that he wants to continue to hear from provider groups. “We want to be a trustworthy partner to identify, validate and diffuse new models of care and payment that improve health care and reduce costs,” he said.