The American Medical Association is recommending significant changes to Medicare's proposed rule establishing accountable care organizations and shared savings programs.

And because the rule proposes a new delivery and payment model, AMA in a comment letter also calls for the Centers for Medicare and Medicaid Services to issue an interim final rule to have flexibility to modify the regulation as lessons are learned.

To start, however, the rule needs fundamental changes in how savings are shared to successfully encourage a greater variety of physician practices to participate in ACOs and shared savings programs, according to the association. It recommends an option allowing ACOs to receive shared savings without the down-side risk. At a minimum, CMS should offer that option to ACOs that qualify for the proposed exemption to the 2 percent net savings threshold, the AMA contends.

Under the proposed rule, CMS already would retain the first 2 percent of any savings and half of any savings from ACOs beyond that threshold, the association notes. "Consequently, all this provision does is penalize the best-performing ACOs and make it even more difficult for them, particularly the small physician practice-driven ACOs, to make the upfront investments needed to achieve savings for Medicare, and therefore we urge that this provision be dropped."

Further, AMA wants CMS to permit physicians to bill for telephone calls with patients and other non-face-to-face services. "The AMA believes that authorizing payment for these codes will actually reduce overall expenditures for Medicare (by reducing preventable hospital admissions and acute care episodes), as well as to improve quality and patient satisfaction," according to the comment letter. "If CMS applies this policy to Track 2, if an ACO bills for these codes but fails to achieve offsetting savings in other areas and thereby increases total Medicare expenditures, the ACO would be required to repay CMS for more than half of the increased costs."

Click here for the full 31-page comment letter.


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