Stipulations under the proposed rule for accountable care organizations that require half of participating primary care physicians to be meaningful users of electronic health records by the second year are unrealistic, says Cecil Wilson, M.D., president of the American Medical Association.

That was one of several issues Wilson raised during a conference in Chicago. Addressing a group of physicians and attorneys gathered for the American Bar Association's annual conference on health law, Wilson said that the ACO concept has potential to improve care and lower costs, but that the proposed rule was laden with problems that would, in effect, block widespread participation. Among them are the "retrospective attribution" provisions of the program, in which patients participating in the Medicare payment model would only be identified after the fact. In the Shared Savings ACO model, Medicare would return a portion of any savings from reduced costs to providers, while simultaneously exposing providers to a certain amount of risk for delivering quality outcomes.

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