CMS Finalizes ACO Medicare Shared Savings Program Rules
By - The Centers for Medicare & Medicaid Services (CMS) announces a final rule updating the Medicare Shared Savings Program. The primary objective of CMS’s actions is to promote high quality care delivery for Medicare beneficiaries and expand upon earlier successes with the Pioneer Accountable Care Organization (ACO) Model.
“The final rule is an effort to provide support for the care provider community in creating a delivery system with better care, smarter spending, and healthier people,” states CMS. The Medicare Shared Savings Program final rule aims to concentrate focus on primary care services and increase program participation through enhanced program flexibility. Modifications to the proposed regulations follow CMS’s consideration of comments received from the December 2014 Notice of Proposed Rulemaking.
“Accountable Care Organizations have shown early but exciting progress in improving quality of care, while providing more patient-centered care at a lower cost,” states Andy Slavitt, CMS Acting Administrator. “The ACO rules today strengthen our ability to reward better care and lay the groundwork for more providers to become successful ACOs,” he adds.
Over 400 ACOs participate in the Medicare Shared Savings Program, which serves 7 million beneficiaries, says CMS. ACOs improved performance in 30 out of 33 quality measures, according to November results claiming those Medicare Shared Savings Program ACOs implemented within the program’s first two years improved beneficiaries’ care quality.
“ACOs are a part of the Department’s broader initiative to create a health care system that results in better care, smarter spending, and healthier people,” CMS confirms. Such a statement alludes to an earlier announced goal to tie 30 percent of Medicare payments to quality and value via alternative payment models, such as ACOs, by 2016 and 50 percent by 2018.
The finalized rule’s outlined program improvements
Yesterday’s announcement of CMS’s final rule aims to improve the program in at least 4 ways:
- Based on several successful elements of the Pioneer ACO Model, CMS states it will create a new Track 3. This includes increased rates of shared savings, a potential assignment of beneficiaries, and new opportunities to use innovative care coordination tools, CMS confirms.
- Combined data shared between CMS and ACOs will be streamlined. This should allow ACOs to access secure patient data more seamlessly. Beneficiaries will reap the rewards of increased quality improvement and enhanced care coordination, states CMS.
- A waiver will be established for the 3-day stay Skilled Nursing Facility (SNF) rule for those beneficiaries assigned to ACOs under Track 3, CMS says.
- To ensure the program continuously provides high quality incentives for ACOs to advance patient care and implement cost savings, the policies for resetting ACO benchmarks will be refined, confirms CMS. More improvements to the benchmarking methodology will be proposed by CMS within 2015, CMS claims.
As RevCycleIntelligence.com reported, 2012 savings to Medicare totaled almost $280 million; 2013 savings totaled $104 million. The Pioneer ACO Model, which stemmed from both a pilot project and Affordable Care Act initiatives, generated $384 million in Medicare savings within two years. This represents an annual average saving of $300 per participating beneficiary.
Pioneer ACO Models are continuing to deliver high-quality patient care. According to CMS, “The Pioneer ACO Model is the first that meets the tests to have its elements incorporated into other Medicare programs.”
The American Medical Association praises CMS’s ACO approach
Robert M. Wah, MD, President of the American Medical Association (AMA) released a statement today in reaction to the new rules for the Medicare Shared Savings Program. Wah commends CMS for recognizing a monotone, one-size-fits-all approach to ACOs is not the best option.
“Maintaining an ACO model that does not require repayment of financial losses will allow many physicians to gain experience analyzing data, improving care coordination and identifying opportunities to improve patient care while reducing spending, which will help prepare them for the implementation of the recent MACRA legislation,” Wah states.
Wah additionally urges CMS to expedite its efforts to accept and approve physician-designed alternative delivery and payment models. He also encourages CMS to accelerate its efforts regarding ACO program expansion.
“The AMA believes the ACO program will be most successful if physicians in each specialty can design and be paid in ways that give them the flexibility to deliver the best care for their patients and allow them to take accountability for the aspects of quality and spending they can manage,” Wah maintains.
