Reproduced with permission from BNA's Health Care Policy Report, 19 HCPR 788 (May 16, 2011). Copyright 2011 by The Bureau of National Affairs, Inc. (800-372-1033) http://www.bna.com
The Medicare Shared Savings Program (MSSP) creates large accountable care organizations to govern and manage the finances of disparate health care providers.
For a century, the medical care industry has operated under Laissez-Faire policies that have favored growth over efficiency. It is time to consider long-term restructuring.
Accountable care organizations (ACOs), a legislative tool of the Patient Protection and Affordable Care Act, are corporate entities that manage costs for groups of health care providers; participating institutions share the resulting savings. This article describes the legal framework that created ACOs; the author considers the broad authority given to the Secretary of the Department of Health and Human Services; other topics include ACO payment models and anti-trust, fraud and tax considerations.
- ACOs must serve at least 5,000 beneficiaries in order to participate in the MSSP.
- The MSSP legislation allows for broad inclusion of health professionals beyond physicians.
- The MSSP statute fails to address the avoidance of high-risk patients.
This article delves into the legal structure of ACOs. The MSSP statute made a number of policy changes that will likely have considerable downstream effects.