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California Medical Association Releases Principles For Physicians to Follow With Accountable Care Organizations (ACOs)

Posted Nov 01 2010 5:18pm

These are some pretty areas lined out, that is if all follow the ideals as prescribed here.  The first rule is important as they want doctors to lead the governance here and not be lead by management or commercial interests.  Insurers are not to image benefit from the savings, and I agree there as they have enough money already and should be happy for the efforts. 

Again we have the reminder about physicians not being allowed to work as employees of hospitals in California and they principles adapted here are stated they should suffice and doctors should not have to be direct employees of hospitals.  BD

CMA’s adopted principles include:

Guiding principle – The goal of an accountable care organization (ACO) is to increase access to care, improve the quality of care and ensure the efficient delivery of care. Within an ACO, a physician’s primary ethical and professional obligation is the well-being and safety of the patient.

ACO governance – ACOs must be physician-led and encourage an environment of collaboration among physicians. ACOs must also be physician-led in order to ensure that a physician’s medical decisions are not based on commercial interests but rather on professional medical judgment that puts patients’ interests first.

Voluntary participation – Patient participation in an ACO should be voluntary rather than a mandatory assignment by Medicare. Any physician organization (including an organization that bills on behalf of physicians under a single tax identification number) or any other entity that creates an ACO must obtain the written affirmative consent of each physician to participate in the ACO. Physicians should not be required to join an ACO as a condition of contracting with Medicare, Medi-Cal or a private payor or being admitted to a hospital medical staff. image

Savings used for patient care – The savings and revenues of an ACO should be retained for patient care services and distributed to the ACO participants. An ACO’s savings and revenues should not go to insurers.

Flexibility in patient referral and antitrust laws – The federal and state anti-kickback and self-referral laws and the federal Civil Monetary Penalties (CMP) statute (which prohibits payments by hospitals to physicians to reduce or limit care) should be sufficiently flexible to allow physicians to collaborate with hospitals in forming ACOs without being employed by the hospitals or ACOs. This is particularly important for physicians in small and medium size practices who may want to remain independent but otherwise integrate and collaborate with other physicians (i.e., so-called virtual integration) for purposes of participating in the ACO.

For more detailed information, please visit CMA’s website to read the full report from CMA’s Physician-Hospital Alignment Technical Advisory Committee. CMA will continue to keep members apprised of all significant developments concerning ACOs and federal health care reform, as they unfold.

If you are experiencing repeated payment delays you should investigate the financial health of the payor. To help physicians monitor the financial health of their contracted payors, CMA has put together a Payor Solvency Checklist . The checklist, available free to members at the members-only website , includes instructions on how to research and monitor the financial solvency of your contracted medical groups/IPAs and discusses options available to physicians in the event a payor stops paying claims.

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