ACO discussion with HCCA at the 17th Annual Compliance Conference

Listening to a panel discussion on ACO's
with Shawn DeGroot, Frank Sheeder, Troy Barsky, and Mary Fischer

Interesting Points

• They are run by providers no VC money involved
• Their board has to be made up of 75% of membership
• ACO's are involved in shared savings, shared risks models
• They are judged on performance benchmarks as a measure of success
• ACO's don't totally follow the OIG 7 elements for compliance but have their own structure and a mandatory compliance position that reports to the board.
•  Privacy concerns along with standard federal guidelines are all still present
• Anti-trust concerns with ACO's DOJ and FTC have published papers on this
• ACO's and physicians share money which raises concerns but waivers are available
• Need to focus on quality data
• Potential for false claims based on bad data(IT Data warehouse be aware!!)
• Need to think about Stark and anti-kickback more about co-mingling of money
• Compliance concern needs to be at the table early and often because of the multiple of potential issues.
• ACO  has to service at least 5000 members 
• Litigation's will be a concern with ACO's if they run a foul of regulations
• Serving people vs. financials concerns are a tightrope
• Compliance is a critical part of making an ACO a success