On November 2, the Centers for Medicare & Medicaid Services (CMS) published in the Federal Register its final rule on The Medicare Shared Savings Program: Accountable Care Organizations (ACOs), a new type of health-care entity created under the Patient Protection and Affordable Care Act (PPACA). The Medicare Shared Savings Program will provide incentives for participating health care providers who agree to work together and become accountable for coordinating care for patients. Providers who work together through this model and who meet certain quality standards based upon patient outcomes, care coordination and other measures, may share in the savings they achieve for the Medicare program. The higher the quality of care providers deliver, the more shared savings the providers may keep.
NOTE: ASH will feature a special information session on the impact of ACOs and other payment and health reforms on hematology practices during the 2011 Annual Meeting Practice Forum, on Saturday, December 10, at 6:30 p.m. Join your colleagues at this special session, where you can learn about the development of ACOs as health-care delivery systems through examples from several hematology practices around the country. The Forum will also provide important information to the practice community that prepares them for the transition to ACOs based on an analysis of the final regulations.
In addition to the final rule on ACOs, CMS also released a new Advanced Payment initiative, a Federal Trade Commission, Department of Justice Issue Final Statement of Antitrust Policy Enforcement Regarding ACOs, and an Interim Final Rule on fraud waivers for Medicare ACOs. The Advance Payment model will provide additional support to physician-owned and rural providers participating in the Medicare Shared Savings Program who also would benefit from additional start-up resources to build the necessary infrastructure, such as new staff or information technology systems.
Based on ASH's analysis, the final rule incorporates significant stakeholder feedback, including ASH's comments submitted earlier in the year to CMS in response to the proposed ACO rule. The final rule includes the following revised provisions:
- Establishes two different tracks for ACOs, but one will be an "upside only" track during the three-year contract period, i.e., the ACO will not be liable to pay CMS if costs actually increase. The second model will include both upside and downside risks, as in the proposed rule.
- Allows providers to avoid penalties if they do not meet savings targets.
- Establishes a more prospective method of assigning beneficiaries. ACOs will get a list of "probable beneficiaries" and the list will be updated quarterly. In assigning beneficiaries, the definition of primary care recognizes that many specialists provide primary care services to patients.
- Includes more flexible governing structures.
- Reduces the number of measurements to assess the quality of care from 65 to 33 metrics.
- Reduces requirements for provider use of electronic health records.
- Provides physicians and rural providers access to up-front capital through the Advanced Payment Model.
- Expands participation of Rural Health Clinics and Federally Qualified Health Centers.
- Includes a more flexible application timetable, which allows providers to seek ACO status through 2012.
Below please find links to several resources CMS has developed concerning ACOs and the Advanced Payment Model program:
If you have any questions, comments, and/or concerns regarding the final rule, please contact ASH Government Relations Manager Stephanie Kaplan (firstname.lastname@example.org or 202-776-0544).
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