Health Law Daily Wrap Up, AGENCY NEWS—Activities of the Accountable Care Organization (ACO) Working Group released by Justice Department and Federal Trade Commission, (Apr 10, 2013)

By Jenny M. Burke, JD MS

Between October 2011 and March 31, 2013, the Accountable Care Organization (ACO) Working Group collaborated and discussed issues concerning ACOs, which were created under the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148) and these activities have just been released. The Department of Justice and the Federal Trade Commission (FTC) established the working group in support of PPACA, which encourages the effort to urge physicians, hospitals and other health care providers to integrate their health care delivery systems in order to improve the quality and reduce the costs of health care services.

ACOs are groups of doctors, hospitals, and other health care providers, who work together to provide coordinated, high quality care to their Medicare patients. The goal is to ensure that patients receive the proper care and avoid unnecessary duplication of services and preventing medical errors. According to CMS, when an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.

The ACO workgroup has been busy answering questions submitted after the antitrust enforcement policy statement regarding ACOs participating in the Medicare Shared Savings Program (MSSP) was released in October, 2011. During the time period covered, the ACO Working Group fielded 33 questions related principally to primary service area (PSA) share calculations, and two requests for voluntary expedited review from proposed ACOs.

Under the policy statement, an ACO may calculate its PSA shares to determine whether it falls within an antitrust safety zone for certain ACOs that are highly likely to raise significant competitive concerns. According to the Justice Department, most of the 33 PSA share questions were responded to by the ACO Workgroup within five business days. Answers to these questions are now being made publicly available on their website.

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