ACOs: Are Things Finally Moving in the Right Direction for Physicians?

by Susanne Madden

I was recently a ‘Guest Expert’ for the Sermo community and engaged the physicians there on a discussion about Accountable Care Organizations (or ACOs): Physician Friend or Foe?. The general consensus was that with the advent of this PPACA-based model, hospitals would hold all the power going forward and physicians would lose what little steerage they have left over their own destinies. With anti-trust laws and physician self-referral limitations in place, it is hard to see how physicians could have any opportunity to own and operate ACOs themselves.

On Thursday, CMS finally released a (429-page!) draft detailing how CMS would implement Medicare payments to providers who participate in ACOs. But that’s not all. The HHS Office of Inspector General followed through on vague-until-now proposals for waivers of certain Federal laws. These cover the physician self-referral law, the anti-kickback statute and specific provisions of the civil monetary penalty law.

This will certainly help to shift some of the brokering back into physicians hands. Add to that the jointly issued  Antitrust Policy Statement from the Federal Trade Commission and the Department of Justice and maybe, just maybe, things are finally moving in the right direction for physicians to take control of the health care delivery model once again.

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