Dr. Coombs: Physicians Must Examine Legal Issues Surrounding ACOs

Much has been written about Accountable Care Organizations and their potential to improve quality and reduce costs, but the legal issues physicians may face as they move to establish arrangements under this new model of care have received less attention.

In an essay in the January edition of Massachusetts Medical Law Report, MMS President Alice Coombs, M.D., outlines the major legal areas physicians must consider when approaching ACOs and urges careful deliberation to avoid unintended consequences.

“Putting aside the economic and clinical questions for a moment,” Dr. Coombs writes, “it’s clear that physicians face substantial legal issues with any ACO design. Physicians – particularly solo-practitioners and those in small practices, who make up the majority of physicians in our state – should proceed with caution, and likely considerable legal help, when approaching ACOs.”

Among the key areas she cites are the corporate practice of medicine, anti-trust and anti-kickback laws, self-referral and the Stark Law, risk-bearing issues, and professional liability. Increasing the complexity for physicians, she adds, is the fact that laws at both the state and Federal levels apply to most, if not all, of these considerations.

While not suggesting that physicians are averse to ACOs, Dr. Coombs says “The varied nature and structure of our current medical delivery system underscore the notion that one size doesn’t – and won’t – fit all as we move to new models of care.  The legal issues may not be insurmountable, but are many and considerable. ”

Read Dr. Coombs’ essay here

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