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  • APTA to CMS: Proposed ACO Rules Require 'Significant Modifications'

    In comments submitted today on the proposed rule on Accountable Care Organizations (ACO), APTA strongly urges the Centers for Medicare and Medicaid Services (CMS) to "recognize the vital role that physical therapists will play" in ACOs and outlines 10 essential revisions that must be made to the proposed Medicare Shared Savings Program (MSSP) before it can be finalized and integrated into the existing Medicare program.

    "Although we feel CMS has made positive progress with the ACO model through this proposed rulemaking, we believe that there are several aspects that require significant modifications to create a seamless, integrated model of care that is in the best interest of Medicare beneficiaries," says the association.

    APTA calls on CMS to require that ACOs make financial and legal records available to all provider participants in a timely manner before contractual agreements are finalized and throughout the 3-year period. In addition, ACOs should be required to provide clear and concise instructions to participants on compliance and quality reporting requirements, APTA says, including timely notification of when and how the ACO has determined that a participant is not in compliance with the stated terms of the agreement and/or the requirements of the MSSP.

    Other recommendations made by APTA include concerns regarding "real clinical integration," quality measures, program integrity and audits, referrals to providers who are not members of an ACO, and self-referral laws. Specifically, the association recommends that CMS establish a prohibition against impeding referrals or care by health care professionals who are not participating in the ACO; thwart anti-competitive behavior in the formation of ACOs; and monitor ACOs to ensure that exceptions to self-referral (Stark II) laws, such as the in-office ancillary services exception, do not result in abusive arrangements and referral practices. Additionally, the association urges the agency to prohibit ACOs from waiving co-pays, giving deep discounts, or offering other incentives to patients to receive services within the ACO.

    In separate comments on the proposed waivers related to fraud and abuse laws, APTA addresses the conflict of interest inherent in physician-owned services and how the in-office ancillary services exception to the physician self-referral (Stark II) law creates abusive financial arrangements. APTA also offers recommendations on avoiding hospital and physician market dominance; the unfair treatment of non-ACO providers; and incentives to confer discounts, waive co-pays, and offer inducements to patients.

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