AAFP Calls for Stronger Primary Care Support in ACO Rules

The AAFP is working to make sure CMS keeps family medicine in mind as the agency writes new rules meant to expand the ranks of accountable care organizations (ACOs), which represent one of the more aggressive attempts to improve patient care.

In a detailed March 23 letter(9 page PDF) responding to a proposed rule on ACO operations, AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., offered CMS Acting Administrator Andy Slavitt critical comments on how patients are assigned, data is shared, benchmarks are established and annual performance measures are reported. He expressed optimism that more small and mid-size practices could participate in the shared savings model if data is shared more readily with primary care physicians.

Patients become part of an ACO based on their choice of physician, a policy that AAPF supports. However, Wergin wrote that when determining a patient's participation in an ACO, more weight should be given to the volume of services from one physician over time rather than a single, more recent visit to another physician. The AAFP also recommended that CMS create an appeals process to allow a physician in an ACO to decline a patient based on the patient's utilization history.

The AAFP also said payment for primary care should reflect both the efficiency and diversity of care as family physicians care for patients with multiple conditions. A greater investment in primary care could help reduce more expensive procedures for patients.