Under construction, under fire

Since the Centers for Medicare and Medicaid Services (CMS) asked for comments on the much-anticipated regulations for accountable care organizations (ACO) in late March, the proposed rules have been under constant attack. Although medical societies, major clinics, and practice groups around the country have broadly supported the concept of ACOs, they have relentlessly criticized the specifics spelled out in the notice of proposed rulemaking. The American Academy of Family Physicians and American College of Physicians recommended several refinements to the structure and governance of ACOs, specifically to help small- to medium-sized practices. CMS does offer one exemption for smaller practices. ACOs with fewer than 10,000 beneficiaries that are comprised of only ACO professionals in group practice arrangements or primarily serve rural communities can share in first dollar savings if they meet the other performance standards. With or without new regulations from CMS, many clinic, hospitals, and physician practices will continue over the coming months to move toward the accountable care model in the commercial market.