The federal government released much-anticipated rules today about how a centerpiece of the federal health care law will work — a program intended to spur medical providers into forming Accountable Care Organizations.
The Obama Administration said ACOs will lower costs and improve the quality of patient care. When the feds released proposed rules last spring, major health systems in Minnesota and around the nation balked at what they considered red tape and micro-management.
A number of major medical systems in the Midwest, including Duluth-based Essentia Health were initially excited about participating in the Medicare shared savings program.
When the proposed regulations came out last April *there was a strong backlash. A survey of large, multi-specialty health systems, the major clinics most likely to form ACOs, found 90 percent saying they wouldn't participate because the rules were too onerous and the investment costs were too high.
Essentia said the new rules were too voluminous to offer immediate comment.
Mayo Clinic, which also objected to the proposed rules earlier this year released a statement that said it looked forward to doing a thorough analysis of the regulations.
But it appears the Centers for Medicare and Medicaid heard the avalanche of comments it received and lightened up on some of those regulations.
"Our initial impression is that they did a pretty good job here," said Karen Ferguson, associate director of regulatory affairs at the American Medical Group Association, a group that represents nearly 400 health systems best suited to become ACOs.
Among the changes: the centers for Medicare and Medicaid cut in half the number of quality measures organizations must meet from 65 to 33; using electronic health records is no longer required to participate; the government will make available $170 million to physician-owned and rural groups to participate.
Ferguson said the AMGA is cautiously optimistic.
"Our initial impression that they did listen to stakeholders and that the changes that they made in the final rule will actually make it easier for people who wish to participate in the ACO program to do so," Ferguson said.
Minnesota's largest doctor's group, the Minnesota Medical Association said the rules appear less burdensome and less rigid. MMA CEO Dr. Bob Meiches of Minneapolis said the new rules might make ACOs more attractive to physicians, but it's still early to tell.
"There's still a lot in there that will cause people to take a closer look, and I think what our hope is that those that were really gung-ho and want to move in this direction will see enough positive that they may be willing to try them."
In St. Paul Thursday, the health care overhaul was the subject of a federal appeals court hearing regarding the law's constitutionality.
Two Missouri residents, Samantha Hill and Lt. Gov. Peter Kinder, object to complying with the law's mandate that they obtain health insurance in 2014 or face a potential penalty. before even getting to the merits of case, there was discussion between the judges and the attorneys about whether Hill and Kinder would even face a penalty for non-compliance. It's possible the panel could join several other appellate courts and decide the law's constitutionality.
One of the appellate court judges, Kermit Bye told the attorneys that they gave the panel some "novel issues to tackle." He said the panel's decision would be out in due course. The Supreme Court is expected to take up the health care law sometime this term.
Elizabeth Stawicki prepared this report as part of a collaboration between MPR News, Kaiser Health News, and NPR.