Medical device makers hope accountable care organizations (ACOs) have the right incentives so doctors aren't punished for being early adopters of new technologies or are encouraged to skimp on care.

The medical device lobby Advanced Medical Technology Association submitted recommendations to the Centers for Medicare and Medicaid Services on Friday for how ACOs can ensure doctors aren't driven to avoid new equipment. The recommendations come as CMS moves to release its ACO regulations later this month, AdvaMed said.

The group is calling for independent monitors of ACOs, caps on individual physician savings, full consent from beneficiaries when added to a plan, and possibly a pass-through system that could help pay for new devices in the first few years they're available.

"ACOs and other payment modality changes are the right recipe for the health reform system, but you really need to get the ingredients right," David Nexon, senior executive vice president of AdvaMed, told reporters on a call Monday.

ACOs have been offered as a way to improve on the current fee-for-service health system. In general, they treat a network of providers as a virtual organization serving a defined patient population.

While payment schemes haven't been completely hammered out, they would likely aim to cut costs by letting physicians pocket a share of the savings if the group's health care costs fall below a certain amount, and if certain quality requirements are met.

CMS will start funding ACOs by 2012. According to the Congressional Budget Office's predictions, about 40 percent of Medicare beneficiaries eventually could be covered by an ACO.

For the device lobbyists, their main concern is that financial incentives, if not worked out correctly, could "chill" the willingness of doctors to adopt new treatments.

"Any time you change the incentives to encourage providers to reduce cost, there's the danger some of them will reduce cost in the wrong way," Nexon said.

Among the group's recommendations is for ACO spending targets or savings pools to include adjustments or add-on payments for new technology for a certain period of time -- say, five years -- while the value of the new drug or device is being assessed. The technology would have to meet certain criteria, and the whole program would be similar to one already existing in Medicare for hospital care.

AdvaMed also wants the quality metrics used by CMS for the ACOs to measure outcomes and not just processes. Otherwise, it could discourage them from using newer products, the group said.

For instance, according to current standards, after a patient has a heart attack, doctors should perform a coronary angioplasty to open up a blocked blood vessel within the first hour or so of admission, Nexon said. But if someone develops a drug or device that's better, the doctor won't use it for fear of getting their quality scored lowered, and thus their reimbursement checks docked.

"The key there is if somebody has a new treatment, new drug, that's an alternative to a new process measure, there should be a grace period where a provider is neither penalized nor rewarded," Nexon said.

Also important is ensuring doctors aren't encouraged to cut costs too much, the group said. For that, the lobby hopes CMS adopts a per capita distribution gain-sharing model, where each physician in a group gets the same reward (or same proportional reward), which is capped at 20 or 30 percent of the total they would earn in a fee-for-service system. Nexon said the office of the inspector general proposed a similar cap during an ACO workshop in October.