Feds address legal concerns about ACOs

With the concept of accountable care organizations (ACOs) gaining steam among physicians and hospitals, several parties have sought reassurance from the Federal Trade Commission that the alliances do not violate antitrust and antifraud laws.

According to Kaiser Health News, providers want to make sure their ACOs won't be accused of stifling competition or trying to fix prices when they bargain with insurance companies. Insurers, meanwhile, are concerned that providers could use the leverage of ACOs to demand higher prices, while medical device makers fear ACOs could encourage doctors to use less costly devices instead of what works best for the patient.

At a meeting held by FTC chairman Jon Leibowitz at CMS headquarters yesterday, Susan DeSanti, director of policy planning at FTC, said the agency is working with CMS on guidelines for forming ACOs. She told the 300 industry representatives present, "The antitrust laws are actually consistent with the goals of ACOs" because they "encourage collaborations when they are going to produce good things for consumers, like improved healthcare, and the only caveat is that the creation of market power shouldn't go along with that." She added that "antitrust is not a barrier here"

CMS administrator Donald Berwick told the panel that the government agencies that oversee doctors and hospitals will work together to give unified guidance on how to form ACOs. "We will need a regulatory framework that nurtures cooperation, while it guards against the lingering threat of inappropriate practices," he said.

Meanwhile, Health and Human Services Inspector General Daniel Levinson promised "fresh thinking" on how his agency would enforce anti-fraud laws prohibiting hospitals from giving doctors any financial inducement for referring patients. "We want to make sure ACOs are not unduly inhibited by existing fraud and abuse laws....Our rules should not stand in the way of improving quality and reducing costs through ACOs," Levinson said.

To learn more:
- read the article from Kaiser Health News
- see this California Healthline piece

Related Articles:
ACO approval deadline approaching faster than you might think
Lawmakers praise ACOs, promise to help overcome obstacles
Physicians, hospitals rush to form ACO alliances