Thursday, March 31, 2011

Oh happy ACO day!

HHS released the long awaited proposed accountable care organization ("ACO") rule today.  Now it's off to the races for hospitals, doctors, and insurers to create these new creatures which are intended to provide higher quality care without locking patients into the provider network like the mean old HMOs. Kaiser Health Care has a helpful FAQ on the ACO rule and it's always interesting to read the AMA News take on the proposed rule which logs in at 429 pages.  The FEHBlog appreciates AHIP President Karen Ignani's comment that
We remain concerned that ACOs could accelerate the trend of provider consolidation that drives up medical prices and result in additional cost-shifting to families and employers with private coverage.  However, we appreciate that CMS, the Department of Justice, and the Federal Trade Commission recognize the potential for consumer harm and are taking steps to address this issue with proposed guidelines for evaluating ACOs and their potential impact on consolidation within the marketplace."  
The proposed rule will be open for public comment during the 60 days following its publication in the Federal Register on April 7.

Tomorrow OPM Director testifies before the House Appropriation's financial services subcommittee in support of his agency's FY 2012 budget proposal. now features a government shutdown countdown on its home page, and the USA Today reports that the government remains on radio silence about the consequences of a shut down.  The Christian Science Monitor and other press outlets report that a compromise is in the works that would avoid a shutdown.

Yesterday, the Labor Department issued its first annual report on self-insured health plans which is an ACA requirement.  Business Insurance informs us that "According to the report, just more than 82% of private-sector employers with at least 500 employees self-insure at least one of their health care plans, compared with nearly 26% for employers with 100 to 499 employees and 13.5% for employers with less than 100 employees." Contrary to HHS, the FEHBlog anticipates that the ACA will incent more employers to self insure their plans in order to avoid, for example, the onerous fees imposed on health insurance carriers beginning in 2014. It's worth noting that the federal government does not self insure its FEHBP. Instead the risk is borne by the carriers which include health insurers, like the Blue Cross Blue Shield Association, employee organizations like GEHA and Mail Handlers, and HMO carriers like Aetna.

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