Manatt Partner Discusses ACO Compliance Concerns 

“ACO Rule Provides Detail but Creates Regulatory Burden for Providers”
Healthcare Risk Management

June 1, 2011 – Manatt’s Robert D. Belfort, a Healthcare partner in the firm’s New York City office, spoke to Healthcare Risk Management about new accountable care organization (ACO) participation rules and the challenges they present for healthcare providers.

Earlier this year, the Centers for Medicare and Medicaid Services (CMS) released nearly 500 pages of proposed rules for ACO participation. The new rules set up quality and savings requirements, but healthcare providers and risk managers have raised compliance concerns.

Belfort notes that the new rules incorporate a downside risk and require primary care physicians to be exclusive to one ACO, but he thinks the biggest challenge for providers to comply with ACO issues will be funding and investment.

“The challenge comes when the doctors and the hospital want to go in on this joint venture, but the doctors don’t have the capital to match what the hospital can do,” Belfort said. “The venture has to be structured in such a way that the government can’t come in and say the hospital is essentially subsidizing the doctors in violation of the fraud and abuse laws or the tax exemption laws.”

He advises providers to waste no time in considering the potential pros and cons of an ACO arrangement. “There is a need for some strategic planning and financial analysis, which I sense a lot of organizations are not doing right now,” he said.