Still No Deal on ACOs

October 22, 2011 - In a blog in The Health Care News, released today, “CMS Wants Docs to Ante Up to ACO Poker Game,”Michael Millenson, a health care consultant, visiting scholar at the Kellogg School of Management, and author of Demanding Medical Excellence and Accountability in the Information Age, concludes,”The ACO program should be attractive enough to entices some of the high rollers names in health care to belly up to the table.” The editor of The Health Care Blog as asked me to respond to Millenson’s post.

Here is what I had to say,

"There's a card game named Dead Man's Poker. It's an apt name for the first ACO rules, released in March 2011, which individual physicians and physicians in large integrated organizations universally declared DOA(Dead on Arrival) because of the time and energy required to set them up and the risks of antitrust review.

Changing the rules of Dead Man's Poker by cutting quality measures friom 65 to 33, offering more flexibility in antirust review, loosening rules of governance and legal structure, altering time to repay losses, being told what Medicare recipients can be part of the ACO, sharing Medicare savings earlier and reducing risk of losing dollars, extending the time to apply throughout 2012, and making $170 million to set up ACOs, expanding payments in rural areas and qualified federal centers, and ending the absolute demand for physicians to have EHRs to participate, does not change the status of ACOs from DOA (Dead on Arrival) to AAB (Alive at Birth).

CMES estimates the new rules will induce 50 to 270 ACOs to form and will save Medicare $960 million."

CMS is whistling past the graveyard. Physicians will not rush to join ACOs. They are waiting to see what the Supreme Court decides on the constitutionality of Obamacare, what the results of the November 2012 election portend, and whether Republicans can succeed in their efforts tto repeal the health care law. Until these things transpire, for most physicians, it will still be no deal on ACOs.

Tweet: CMS has issued a new rules for ACOs to induce doctors and hospitals to form these organizations. To most MDs, it will still be no deal.