One of the most controversial provisions of the proposed rule for accountable care organizations is the "retrospective attribution" of patients. Under the rules, an ACO would only learn the identity of the Medicare patients assigned to it after the fact.

Speaking at the annual conference of the Health Care Financial Management Association in Orlando, Nicholas Wolter, M.D., said he hopes that regulators will reverse their policy on this aspect of ACO management. "If patients feel like they are part of something, we would have higher success," he said during his presentation. Wolter is CEO at Billings (Mont.) Clinic, an integrated delivery system that includes a hospital and group practice.

Billings was one of 10 national demonstration projects on ACOs. The proposed rules, while problematic, could be modified to make the ACO idea more palatable, Wolter noted. He bemoaned calls for the repeal of the health care reform law, which put the ACO effort into gear. Taken in aggregate, the demonstration projects revealed the potential of the ACO model--which rewards providers for meeting quality goals and reducing costs, he said.

Billings had 500 patients enrolled in its demonstration, which coordinated care across inpatient and clinic setting. The effort was facilitated with an electronic health record and a physician scorecard that portrayed adherence to quality measures among diabetic patients. "We had significantly lower costs with these patients," he said.


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