CMS Administrator Donald Berwick, M.D.

With the comment period on accountable care organizations now over, stakeholders and some politicians are clear on one issue: The ACO program needs work.

Provider groups, including the American Medical Association and the Premier healthcare alliance, sent the Centers for Medicare & Medicaid Services comment letters that were supportive of the ACO idea but critical of implementation plans. Seven Republican Senators asked CMS to withdraw the proposed ACO regulation, according to a letter released in May.

Accountable care organizations provide incentives to healthcare organizations, including long-term care providers, to provide quality care for less money. Organizations can recoup savings earned through better care or suffer the consequences of preventable and costly errors. But providers must follow a series of rules to qualify, and some have said the start-up costs to an ACO are insurmountable. Many of the organizations have asked CMS to make financial terms of the ACO program more lucrative, such as increasing the maximum shared savings rate.