The comment period ended, but the story on ACOs is far from over

Since the Centers for Medicare & Medicaid Services ended its comment period on the Accountable Care Organizations (ACOs) proposed rules this past Monday, a slew of healthcare association recommendations have surfaced. What’s noteworthy is that the commentary shows provider groups have little confidence in CMS’ ability to get this right.

Perhaps the most glaring of these messages came from the American Medical Association, which requested that ACO final rules be classified as “interim” final rules. The interim designation would allow the rules to be commented on and molded even after their implementation. Strong faith in CMS, this does not show.

Long-Term Living Editor-in-Chief Patricia Sheehan blogged earlier this week that Cynthia Morton, executive vice president for the National Association for the Support of Long Term Care, while speaking at an eHealth Data Solutions user conference in Cleveland, wrote off ACOs in her address as “a nothing burger for nursing homes.”

LeadingAge released the comments that it submitted to CMS, which had a more positive spin. But the association could not refrain from implying that the inherent vagaries of the rules are going to keep people guessing until fall, when the final rules are expected. “It should be noted that this is going to be one of many such iterations of this experiment, and multiple different models and types of Accountable Care Organizations—different in both who is going to be ‘accountable’ and how that will be defined, as well as what will likely constitute an ‘organization,’” LeadingAge wrote.

ACO expert Kathleen Griffin, PhD, national director of post acute and senior services at consulting firm Health Dimensions Group, shared a similar outlook to me in a recent interview. Her message: wait and see. All the squawking about Medicare ACOs may be for naught when CMS digests the comments and reengineers its rules. If healthcare systems find the final rules to be attractive, they’ll be singing a different tune.

“Medicare fee for service is not getting any easier for hospitals, so once you put the infrastructure in place to be an integrated healthcare delivery system for insurers, then your readiness factor for being an ACO under Medicare becomes much easier,” Griffin told me. “At some point in time, it will make financial sense to be a Medicare ACO.”

The evolution of these final rules may yet be one of the more intriguing healthcare stories in some time. Could CMS react to the criticism levied at ACOs and release rules that please all parties—even post-acute providers, who’ve been offered essentially little room in the discussion? We’ll just have to stay tuned.

Kevin Kolus

Kevin Kolus wrote for I Advance Senior Care / Long-Term Living when he was an editor. He left the brand in 2012. He is now senior communications manager at Cleveland Clinic.