ACO Workload

The final Shared Savings ACO regulation was published November 2, 2011 in the Federal Register. As I was reading through these regulations, I kept thinking about Bob Berenson’s remark at a recent Health Affairs meeting where he said that CMS has fewer staff today than they did in the 1980s.  How have they managed all of this new regulatory work on top of the routine issuance of annual fee schedule updates and other regulatory workloads?  And what about the potential 270 ACOs that might apply? And now CMS is responsible for all of the ACA regulations and implementation such as overseeing the development of new exchanges in all of the states.  In the meantime, CMS has implemented the Medicare Modernization Act which substantially increased the number of Medicare Advantage plans and added a whole new workload of Prescription Drug Plans. For MMA, CMS at least received some contract funding. I am wondering what will happen to staffing and funding as a result of the action or inaction of the Super Committee.