health reform: a federal summit on acos

  • 1st October 20101/10/10

On Tuesday, October 5, 2010, the federal government will host a workshop on legal issues related to the development of accountable care organizations (“ACOs”).

ACO became a buzz word in the wake of health insurance reform this past March 2010. Two sections of the Patient Protection and Affordable Care Act (Public Law 111-148) created pilot programs in the Medicare and Medicaid programs to test out the concept of using an ACO to deliver cost-effective medical care (see sections 2706 and 3022). Although these were minor sections of the reform law, ACO development has received a tremendous amount of attention in medical and legal communities.

There has been so much attention that the federal government is bringing together panels of speakers from the Federal Trade Commission (“FTC”) and the Department of Health and Human Services (“HHS”) to talk about the two main risk areas for ACO development: antitrust and antifraud laws.

The collaboration between independent health care providers usually presents some risk of anti-competitive conduct in a particular geographic market as well as some risk of Medicare or Medicaid violations if patient referrals are inappropriately paid for. Hopefully, the summit will explain those issues clearly and provide listeners some insight on whether there will be changes made to the legal playing field or if providers are left to figure all this out with the laws remaining as is.

For those who cannot attend the workshop in person, there will be options to listen in via a web cast (morning and afternoon sessions) or teleconference (afternoon session only). The reason to listen in will be to figure out what the FTC and HHS are concerned about and what industry leaders may be pushing for. If there are gaps in representation of industry stakeholders at the workshop, that should become evident too.