Doug Hastings Featured in Article About the Treatment of Duals in ACOs

Inside CMS

Doug Hastings, Chair of the Board of Directors and a Member of the Firm's Health Care and Life Sciences practice in the Washington, D.C., office, was featured in an article titled, "Beneficiary Advocates Worry about Treatment of Duals in ACOs."

According to the article, Medicare beneficiary advocates have raised concerns with administration officials that many providers in accountable care organizations (ACOs) may not be Medicaid providers and as a result dual-eligible beneficiaries could end up paying for Medicare "cost sharing" that is supposed to be paid for by Medicaid. The article states that the goal of ACOs is to coordinate patient care, and beneficiary advocates say dual eligibles are the population in greatest need of coordinated care, but including too few Medicaid doctors in ACOs would discourage that very population from seeking treatment within ACOs.

About attribution of patients, Hastings, a respected voice on ACO policy, said that his understanding is that there is "a good debate" going on at CMS about this issue.

His advice: "Don't disclose individual patient names to the ACOs. You might over time give them aggregate data, but the idea is that they should be good for everyone. Yeah, they can't control out of panel usage, but if they are really hitting the metrics showing good patient satisfaction, they will come." Hastings said he hadn't heard about the potential problem with duals and ACOs.