Safe harbors on the way for Accountable Health Organizations

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Safe harbor for ACOs?Accountable Health Organizations have the potential to generate some of the efficiencies people admire in integrated groups like the Mayo and Cleveland Clinics.  And by 2012, ACOs will get the ultimate seal of establishment approval, qualifying for Medicare incentive payments.

But will the legal structure work?  Some attorneys have begun to suggest that such groups might raise antitrust and anti-fraud issues. And it’s no surprise — after all, on paper a loosely-coupled organization could run into federal self-referral or fraud beefs fairly easily.

Worried that they may be stepping into a quagmire, hospital and doctor groups have begun asking federal regulators for guidance on which ACO models fall safely within federal law.  Among other requests, hospitals are asking HHS to explain how physician-hospital ACOs can get a waiver excusing them from standard fraud and abuse regulations.

Help is on the way, however. In fact, the FTC is now working with CMS on guidelines for forming ACOs that pass legal muster.  It’s worth noting that the agencies aren’t trying to slow ACO growth down, by the way. In fact, “the antitrust laws are actually consistent with the goals of ACOs,” because they encourage collaborations which assist consumers in getting better healthcare, an FTC official told California Healthline.

Meanwhile, FTC Chair Jon Leibowitz is looking into creating new antitrust safe harbors and an expedited ACO review process.  With any luck, this will help physicians and hospitals form up their teams early and well.

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Kellye Wms October 28, 2010 at 5:52 pm

While I mostly believe a detachment of the chairperson and CEO is a serious matter, particularly in public companies, it is not a solid answer to ready two people of like ages, great egos and healthy ambitiousness in this kind of positioning relative to each other. They tell a camel is a horse designed by a committee. This is a 2 humped camel.


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