Health Care thoughts: The New, New Thing Hits a Snag
by Tom aka Rusty Rustbelt
Health Care: The New, New Thing Hits a Snag
The feds are starting to push “accountable care organizations” (ACOs) as a means of improving care while bending the cost curve, and providers appear eager to join the movement.
Problem is, it appears ACO participants could violate general antitrust laws and the Stark health care transaction laws.
Secretary Berwick (DHHS) is promising changes so ACOs can move forward. Congress currently is occupied elsewhere.
(Dan here…now if only we could get Rusty to say this in English with some context.)
DAn, I’m having some difficulty in finding functioning ACOs. As a concept it may be well recieved, but my concern is, like HMOs, will ACOs need more legislation to protect them from law suits or other unanticipated legal problems?
Touche. Let me fix lunch for my favorite nurse and I will put some explanation in the comments.
An accountable care organization (ACO) is an integrated system working toward the capability of providing and coordinating the entire contiuum of care (or most of the continuum of care) for a patient. This should improve quality of care and contain costs, theroetically anyway.
There is no exact ACO definition at this point, and no perfect model, it is evolving.
PPACA (Obamacare) included some incentives to start moving in this direction. The combination of increased regulation and probable new payment methods (bundling for example) has lit a fire under the concept, providers are moving fast.
Problem is, there is no exact definiion and no one is certain how legal and regulatory franeworks apply, so it is a little like improv acting.
One implication of ACO is that standards of care will be developed based upon experience. Physicians know that this means that many of them will be overskilled for a lot of the new environment (it won’t take 8-10 years post BS to get the training needed). Of course this also involves all hospital treatment being run by hospitalists no primary care physicians needed. Standards of care mean less judgment by the practicioner and more following of proceedures as in most other scientific realms.
As an antitrust lawyer, an ACO which undertakes risk and/or offers a new product, should be able to fit in under existing antitrust joint venture guidelines.
The problem would arise if the ACO had, for example, exclusives with critical hospitals such that a competing organization could not develop.
This is a non-issue, unless you are a hospital that is looking for an exemption.