Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program, FTC Matter No: V100017 #00012 

Submission Number:
00012 
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 30% Safety Zone for "common services" - these should be specified as 'specialty' services, not including primary care. Due to the shortage of primary care providers in many areas, to obtain the 5000 Medicare beneficiaries needed to form an ACO, enough of the primary care providers would need to participate that the 30% limitation would be routinely exceeded. Although doctors of other specialties may provide primary care, there may be no other doctors in the PSA. E.g., consider the case of a rural PSA with three solo physicians. The current language would have the effect of excluding most primary care physicians in underserved areas from inclusion in an ACO. Current: "For an ACO to fall within the safety zone, independent ACO participants (e.g., physician group practices) that provide the same service (a “common service”) must have a combined share of 30 percent or less of each common service in each participant’s PSA, wherever two or more ACO participants provide that service to patients from that PSA. The PSA for each service is defined as “the lowest number of contiguous postal zip codes from which the [ACO participant] draws at least 75 percent of its [patients]” for that service. " Proposed change: "For an ACO to fall within the safety zone, independent ACO participants (e.g., physician group practices) that provide the same specialty service (a “common service”, not to include primary care) must have a combined share of 30 percent or less of each common service in each participant’s PSA, wherever two or more ACO participants provide that service to patients from that PSA." OR "For an ACO to fall within the safety zone, independent ACO participants (e.g., physician group practices) that provide the same non-primary care service (a “common service”) must have a combined share of 30 percent or less of each common service in each participant’s PSA, wherever two or more ACO participants provide that service to patients from that PSA."