New Study Examines the Impact of the ACO Rule on Medically Underserved Populations

Released: 20-Apr-2011 11:00 AM EDT
Source Newsroom: George Washington University
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Newswise — WASHINGTON and NEW YORK - A new policy research brief from the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University School of Public Health and Health Services examines the impact on medically underserved Medicare beneficiaries of CMS’ proposed rule implementing the Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs). The report, titled “ Medicare’s Accountable Care Organization Regulations: How Will Medicare Beneficiaries who Reside in Medically Underserved Communities Fare?” finds that the regulation excludes from the anticipated benefits of ACO growth over 1.4 million Medicare beneficiaries who receive their primary care from federally qualified health centers (FQHCs). The exclusion arises from an interpretation of the law by the Centers for Medicare and Medicaid Services (CMS) that excludes patients whose physicians practice as part of health care teams that bill globally for their care, despite the fact that health care teams are essential to overcome the impact of severe physician shortages in medically underserved communities. The report also concludes that the rule has an equally serious impact on Medicare patients served by rural health clinics (RHCs).

“CMS has attempted to craft a modest financial incentive in order to encourage ACOs to overcome the effects of its interpretation and include FQHCs and RHCs. But the incentive is unworkable and—more importantly—cannot overcome the impact of a policy that simply put, states that millions of medically underserved patients don’t count when calculating shared savings,” said Sara Rosenbaum, Harold and Jane Hirsh Professor of Health Law and Policy and lead author of the study.

“CMS stresses the critical role of health centers to the nation’s health care system, and indeed, health centers play a significant and increasing role in caring for Medicare beneficiaries,” noted Julio Bellber, President and CEO of the RCHN Community Health Foundation. “Yet the regulation makes participation in ACO advances a near-impossibility for health centers and their patients.”

Lauding the improvements in quality and efficiency potentially realized through the formation of ACOs, the study recommends the development of an alternative approach to CMS’ proposed patient assignment policy that will eliminate its exclusionary impact on medically underserved populations.

The full Brief can be accessed here:
http://www.gwumc.edu/sphhs/departments/
healthpolicy/dhp_publications/pub_uploads/
dhpPublication_6EFAAA15-5056-9D20-3DBE579D20C06F05.pdf


About the Geiger Gibson / RCHN Community Health Foundation Research Collaborative
The Geiger Gibson Program in Community Health Policy, established in 2003 and named after human rights and health center pioneers Drs. H. Jack Geiger and Count Gibson, is part of the School of Public Health and Health Services at The George Washington University. It focuses on the history and contributions of health centers and the major policy issues that affect health centers, their communities, and the patients that they serve.

The RCHN Community Health Foundation (RCHN CHF), founded in October 2005, is a not-for-profit foundation whose mission is to support community health centers through strategic investment, outreach, education, and cutting-edge health policy research. The only foundation in the country dedicated to community health centers, the Foundation builds on health centers’ 40-year commitment to the provision of accessible, high quality, community-based healthcare services for underserved and medically vulnerable populations. The Foundation’s gift to the Geiger Gibson program supports health center research and scholarship. For more information on RCHN CHF, visit www.rchnfoundation.org

Additional information about the Research Collaborative can be found online at gwumc.edu/sphhs/departments/healthpolicy/ggprogram or at rchnfoundation.org.

About The George Washington University Medical Center
The George Washington University Medical Center is an internationally recognized interdisciplinary academic health center that has consistently provided high-quality medical care in the Washington, D.C. metropolitan area since 1824. The Medical Center comprises the School of Medicine and Health Sciences, the 11th oldest medical school in the country; the School of Public Health and Health Services, the only such school in the nation’s capital; GW School of Nursing; GW Hospital, and The GW Medical Faculty Associates. For more information on GWUMC, visit www.gwumc.edu.


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