Hanlon Bush Investments, LLC-CO

The new proposed rule for the ACO has concerns for indepentant providers such as myself. The health care system in Fort Collins is heavly controlled by the local hospital. The local hospital owns the majority of the physician practices, ortopedic center, cardiology center, has a joint venture with a for-profit skilled nursing facility, and joint venture with the local home health company. The newly created ACO through CMS could potentially create an entire network that will put me out of business. As it stands know, the joint venture between the local hospital and the joint venture SNF monopolizes the Medicare A referrals. Recently, the hospital closed its campus for marketing staff to visit discharge planners for potential admissions. This does not apply to the marketing staff the hospital has a joint venture with. Therefore, the marketing staff is allowed to roam the hospital with the discharge planners. The newly created ACO has the potential for the hospital to only work with its joint venture SNF which will put me out of business. Is there going to be any regulation and/or consideration restricting a local hospital with a vast monopoly from creating an ACO within its ownership? From my understanding, the "self referral" laws in Stark, restrict any organization from referring patients directly to their ownership.