WASHINGTON — The Obama administration proposed much-anticipated rules Thursday to spur controversial changes in the way that health care for older Americans is organized and paid for.
The rules lay out a path for doctors, hospitals and other providers of care to form teams called "accountable care organizations" that advocates say would save money by better coordinating medical services for Medicare patients.
Under the rules, teams that treat patients for less money would be rewarded financially by the government if they also meet certain measures of quality.
Health and Human Services officials predicted Thursday that the Medicare ACOs, as the arrangements are called, will save the financially strained program $510 million to $960 million during the first three years after they go into effect in January. Critics have worried that the arrangements could, instead, become large health care monopolies that could suppress competition for patients and, as a result, drive up costs.
ACOs are a recent form of managed care that differs sharply from older health maintenance organizations, which were widely unpopular. In contrast, ACOs are run by doctors or hospitals, rather than by insurance companies. Some such organizations already have sprung up around the country, but the federal law enacted a year ago to overhaul the nation's health care system tries to spur their development by weaving them into the large Medicare program.
In announcing the proposed rules, Donald Berwick, administrator of the Health and Human Services department's Centers for Medicare and Medicaid Services, praised ACOs as an "exciting and productive" way to overcome the fragmentation of care for older patients, most of whom have several chronic medical problems that sometimes are treated by doctors who do not communicate with one another. Berwick said ACOs encourage doctors, hospitals, nurses and other care-givers to share medical records, emphasize preventive care and "invest in keeping people healthy."
Unlike in Medicare Advantage, the managed care part of Medicare, patients will not sign up for an accountable care organization. Instead, they will be assigned to one after the fact if their primary doctor belongs to it. To qualify as an ACO, the rules say, the doctors or hospitals that run one must be able to provide primary care for at least 5,000 patients.