Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program, FTC Matter No: V100017 #00011 

Submission Number:
00011 
Commenter:
Peter Liepmann
Organization:
Peter J Liepmann MD LLC
State:
New York
Initiative Name:
Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program, FTC Matter No: V100017

An important clarification regarding the Dominant Provider Limitation- this must not include primary care as a 'service' subject to this limitation, since primary care providers may only participate in one ACO. Due to the shortage of primary care providers in many rural areas, to obtain the 5000 Medicare beneficiaries needed to form an ACO, enough of the primary care providers would need to participate that the 50% limitation could be exceeded. Although doctors of other specialties may provide primary care, there may be no other doctors in the PSA. "Dominant Provider Limitation: This limitation applies to any ACO that includes a participant with a greater than 50 percent share in its PSA of any service that no other ACO participant provides to patients in that PSA. Under these conditions, the ACO participant (a “dominant provider”) must be non-exclusive to the ACO to fall within the safety zone. " E.g., consider the case of a rural PSA with just one primary care group or physician, and no other physicians. Proposed change: "Dominant Provider Limitation: This limitation applies to any ACO that includes a non-primary care participant with a greater than 50 percent share in its PSA of any service that no other ACO participant provides to patients in that PSA. Under these conditions, the ACO participant (a “dominant provider”) must be non-exclusive to the ACO to fall within the safety zone.