Yesterday, APTA attended the Federal Trade Commission's (FTC) workshop on the Proposed Statement of Antitrust Enforcement Policy, which addresses how the federal agencies will enforce antitrust laws when competing health care providers create new Accountable Care Organizations (ACOs). The workshop featured 2 panel discussions with a variety of industry stakeholders, including private legal counsel for several health care providers and insurers, academics, health policy and economic experts, and representatives of the FTC and the Department of Justice (DOJ).
Panelists raised questions and concerns regarding the January 1, 2012, formation date of ACOs; the types of organizations that will be covered; whether patient choice will be limited due to the number of small practices that join ACOs; and if the mandatory 90-day review period is sufficient to make an appropriate determination as to whether the ACO is pro or anti-competitive. Panelists felt strongly that the administrative burden of calculating primary service area data and proving compliance should fall on the agencies and not the providers, and that the FTC and DOJ should take a law enforcement approach rather than a regulatory approach to oversight. Additionally, the experts addressed the Centers for Medicare and Medicaid Services' eligibility criteria for the Shared Savings Program, asked how possible cost-shifting from Medicare to commercial markets would be monitored, and explored issues of exclusivity—in particular, if hospitals could participate in more than 1 ACO. Other topics included the antitrust "safety zones" for ACOs that meet certain criteria, the rural exception to the safety zone provision, and how ACOs can reduce unnecessary health care services.
The comment period for the FTC and DOJ joint proposed policy statement ends May 31. APTA members are encouraged to submit their input to the association on this proposal and the other ACO proposed rules by May 15 to be included in APTA's comments to the federal agencies. Members should e-mail their input to ACOcomments@apta.org.
What is the future of PT private practice with the formation of ACO's. From our stand point things look VERY insecure. What is the APTA doing to protect PT private practice...what can we do to help ourselves ???
Posted by Chris Newell/ Jorge Battilana
on 5/11/2011 2:39 PM
How is this ACO set-up any different than physician owned practices or the referral services run by hospitals to their own facilities? How is this in any way ----a positive for the private practitioner? How does this promote the APTA 2020 agenda of autonomy and independent practice for our profession?
Posted by Robert Crossett
on 5/14/2011 6:57 AM
ACOs do offer a POSITIVE alternative to the present situation. But, there are always possibilities for unintended consequences. Please recognize how broken fee for service is. Second, recognize the plethora of insurance companies and regulations you presently deal with in private practice. Third, recognize that no where in the present system is there ANY incentive for a positive outcome nor is there any way to measure when you provide care that reduces the overall cost of an individuals care (preventing MRIs, preventing surgery, preventing falls). Those are the real areas where PTs can positively impact outcomes--not seeing people "only 6 visits" and never monitoring whether those 6 visits made a difference)!
I am in a private practice. I am working on being part of an ACO with the largest hospital system in the area. I am doing it because this is the way to recognize the incredible impact I have on my patients--the present system has never rewarded me in any way for having a positive impact; in fact, it has penalized me in less revenue and having to work harder than other PTs. So, review this list and then you will be able to count ways in which an ACO is positive for a private practitioner (but only if you are able to reduce costs of care OVERALL which will probably INCREASE how much is spent on PT and LESS on MRIs, injections, surgeries--see Virginia Mason for a case study). So, more power to the APTA for trying to help PTs get on the bus. For those of us that can't figure out how to compete against a surgeon for most orthopedic problems and have a positive impact on preventing many disease processes, get out of the way. For those of us excited about the opportunity for being rewarded for doing a excellent job, all I can say is that finally there is a chance that our huge impact MIGHT be recognized--most likely obstructionists will prevail in most markets and PTs will be stuck with REDUCED fee-for-service and low per diems. All I can ask, has anyone's reimbursement increased under fee for service? NO. It might under and ACO--not guaranteed, but it might. It did at Virginia Mason and the PT reimbursement was already over twice what I get in Georgia.
Posted by Herb Silve
on 5/15/2011 9:01 AM
The danger of course is that corporate (even non profit corporate) health care systems will "capture" the market. Despite language in the ACO regulations that enables choice of providers by the patient, we fear that the referral patterns will tighten to prioritize ACO members and visits to non ACO members will get limited.
The opportunity is to join with primary care provider groups who will come to see surgery and the neglect of PT-treatable conditions (balance, weakness, metabolic instability, etc.) as financial risks needing management. We can help them.
The question is can the APTA provide us with the documentation and presentation to get our foot in the door. What structure should we have in approaching the potential ACO groups in our community? Should we go in as a solo practice? Should we merge into a small network w colleagues to offer a broader base of participants (and potentially be able to join in the financial risks/ rewards)? I need some help on these questions. I am looking for those in the APTA to help me as I am busy just staying afloat. And I see such a small picture of the territory that the ACO will cover (OP PT is <2% of health care dollars).
Posted by Jonathan Holtz
on 5/16/2011 9:26 AM
APTA will be advocating for its members in the ACO proposed rule and the fraud and abuse waiver and antitrust proposed notices to “protect the PT private practice.” The association's comments will be posted on www.apta.org in the next couple weeks as the deadlines are approaching for both rules. (The deadline for ACO comments is June 6. Comments are due on antitrust laws May 31.)
Posted by News Now
on 5/25/2011 9:10 AM