ACOs Not for Faint-Hearted Physicians

Thursday, January 20th, 2011
This post was written by Patricia Donovan

The most successful accountable care organizations will be those whose physicians have an active hand in developing the ACO architecture, predicts Jeffrey R. Ruggiero, an attorney advising the Queens County Medical Society on its ACO development approach.

Contrary to past attempts to reform the healthcare system, there is a much greater willingness today by physicians to embrace ACOs, to give up some of their autonomy and to practice with peers, said Ruggiero during yesterday’s webinar on Physician-Owned ACOs: Overcoming the Legal and Regulatory Compliance Challenges. The CMS Shared Savings Program, which will enable ACOs for Medicare beneficiaries beginning in January 2012, should be sharing its final rules by the end of this month, Ruggiero noted.

The most important consideration in ACO creation is who will manage the accountable care organization, said Ruggiero, a partner in the law firm of Arnold & Porter LLP. The best ACO leaders will share a strategic vision, will be able to articulate that vision and will encourage participation among their peers. He recommends that interested organizations identify a core group of 40 to 50 doctors who are willing to explore ACO formation. The Queens County Medical Society ACO, comprised of more than 700 local physicians, will be one of the largest physician-owned ACOs in New York State.

Beyond management considerations, the legal and regulatory ramifications of the ACO model can be daunting, said Ruggiero. More than 30 federal entities help to police the healthcare industry, and there are at least five types of state laws to consider when creating an ACO.

Ruggiero also walked through the antitrust considerations, fraud and abuse compliance, and the financial and administrative structure of a physician-owned ACO. Listen to an interview with Jeffrey Ruggiero.

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