Revised accountable care organization rules released Thursday by the Centers for Medicare and Medicaid Services took into account the objections of health care providers in an effort to convince more to get on board with a program CMS chief Donald Berwick says is the next, best hope for Medicare. So far, while they've all issued caveats saying they have to finish slogging through all 696 pages of the guidelines, the official medical societies seem, tentatively, happy with the changes.

The American Medical Association, for instance, which represents probably about one-fifth of U.S. doctors, said it was "pleased" that CMS included many of its suggestions to the original draft proposals, floated at the end of March, such as reducing the amount of reportable quality measures and limiting financial risk to doctors in one optional ACO track.

"After preliminary review, the AMA believes this final rule includes a number of positive changes," Dr. Peter W. Carmel, the association's president, said in a statement.

Similarly, the American College of Physicians said it "applauded" the CMS for making the regulations more doctor-friendly. It also welcomed interim final rules, also released Thursday, that provide certain exemptions from federal anti-trust rules so doctors can participate in the ACO plans without getting in hot water with the law.

But the new regulations still haven't won over one group: medical device manufacturers.

You see, the ACOs are meant to coordinate care among different physicians. The idea is that by working together to, say, keep chronically ill patients well enough to stay out of the hospital, doctors can help drive health care costs down. As an incentive, doctors could also pocket a share of the savings.

But since at least December, the Advanced Medical Technology Association (AdvaMed), a medical device manufacturers lobby, has been warning that these cost-saving ACO rules have to be designed in such a way that that they don't punish doctors for adopting new technology or otherwise encourage providers to "stint on care." And they don't think the draft rules released in the spring, which they commented on, or the new rules released Thursday, do that.

"This rule is a missed opportunity to ensure that the sweeping changes in payment policy established by the Affordable Care Act will support medical progress and assure that patients can receive the care most appropriate for their needs," Ann-Marie Lynch, executive vice president with AdvaMed, said in a statement Thursday.

"Without certain design elements, the ACO program may have the effect of limiting treatment options and discouraging physicians from adopting new advancements in care," Lynch said. "CMS failed to include or even discuss common-sense provisions to support continued medical progress, despite concerns expressed by the life science industry, patient groups and members of Congress."

Over the summer, AdvaMed called on CMS to include in the final rules features such as financial protections for doctors buying new technology and an independent panel to monitor ACO beneficiary claims to ensure providers weren't skimping on appropriate services.

For the new revisions, AdvaMed was especially unhappy about a move that the doctors' groups welcomed: the dropping of quality measures from 65, in the draft rules, to 33 in the final ones.

"The final rule lacks sufficient measures of patient outcomes to assure quality of care. There are large areas of clinical practice not addressed at all -- including cancer, severe arthritis, chronic pain and osteoporosis," Lynch said.