The Centers for Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), and the Department of Health and Human Services (HHS) Office of Inspector General (OIG) will co-host a workshop on October 5, 2010 to address anti-trust, physician self-referral, anti-kickback and civil monetary penalty issues for Accountable Care Organizations (ACOs). ACOs are a new form of an integrated delivery system that was established as a demonstration project within the Medicare program by the Patient Protection and Affordable Care Act on March 23, 2010.

HHS is required to establish a shared savings program specifically relating to ACOs no later than January 1, 2010. CMS announced that it plans to release proposed regulations for ACOs later this fall.

ACOs will be accountable under three year contracts with CMS for the quality, cost and overall care of at least 5,000 Medicare beneficiaries assigned to the ACO. Medicare beneficiaries will be assigned to an ACO based on the selection of primary care service providers. Each ACO will be required to have a sufficient number of primary care professionals to care for the assigned Medicare beneficiaries.

An ACO must establish a mechanism for shared governance and a formal legal structure to receive and distribute payments for shared savings among the following types of providers:

  • Physicians in group practice arrangements
  • Networks of individual practices of physicians
  • Partnerships or joint venture arrangements between hospitals and physicians
  • Hospitals and their employed physicians
  • Other groups of providers of services and suppliers as the Secretary determines appropriate

The workshop will be held at CMS Headquarters in Baltimore, Maryland, and is open to the public. The announcement by the FTC noted that to facilitate providers’ efforts to develop ACOs that will provide high quality, lower-cost care to their patients, the workshop will address and solicit public comments on the legal issues raised by various ACO models being considered by health care providers.  

A notice will be published by the agencies in the Federal Register with additional details on the workshop and the topics to be covered during the day-long workshop. The deadline to submit comments to be included in the discussion at the workshop is September 27, 2010, and the public may submit comments to the agencies before the workshop.

A copy of the FTC’s announcement on the ACO workshop may be obtained here.