Wednesday, September 15, 2010

5 Key Regulatory Concerns for ACOs

Hospitals looking to develop accountable care organizations face the same regulatory concerns and hurdles that hospitals have long grappled with in their physician integration efforts. Specifically, ACOs must ensure that their agreements with physicians do not violate anti-kickback statutes, Stark Law, the Civil Monetary Penalty, tax-exemption laws and/or anti-trust regulations.

Previous and current Medicare demonstration projects involving bundled or incentive payments have granted exceptions to many of these regulations, and it is expected the Medicare ACO demonstration created by the Patient Protection and Affordable Care Act will do the same, although specific guidelines for the project will not be released until December. Given that specific guidelines are forthcoming, hospitals that develop ACOs must consider how their integration efforts will be viewed in light of these regulations.

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