CMS Proposes Rule Changes for Accountable Care Organizations
Several potential new rules would strengthen the Medicare Shared Savings Program by altering risk/reward, enrollment and more.
- Yesterday, the Centers for Medicare and Medicaid Services (CMS) announced several proposed changes that will strengthen the Shared Savings Program for Accountable Care organizations (ACOs). This will happen through a greater emphasis on primary care services and promoting transitions to performance-based risk arrangements.
The new rule reflects input from program participants, experts, consumer groups and the stakeholder community at larger. Through the Affordable Care Act, ACOs are encouraging doctors, hospitals and other healthcare providers to work in unison to keep patients healthy and out of the hospital. This helps reduce the growth in healthcare costs and improve quality of care. ACOs are eligible to share savings with Medicare when they deliver care more efficiently while meeting or exceeding performance benchmarks for quality,
“This proposed rule is part of our continued commitment to rewarding value and care coordination – rather than volume and care duplication,” CMS Administrator Marilyn Tavenner said in the press release. “We look forward to partnering with providers and stakeholders to continuously refine and improve the Medicare Shared Savings program.”
The Shared Savings program includes more than 330 ACOs in 47 states, providing care to more than 4.9 million beneficiaries in Medicare fee-for-service options. Over the first year of the program, 58 ACOs in the program held spending below the benchmark total of $705 million and earned shared savings payments of more than $315 million. An additional 60 ACOs were below the expenditures benchmark but not low enough to qualify for shared savings.
The new rules proposed several changes that will impact ACOs participating in all three tracks of the Shared Savings program. These include:
Participation in Track 1 – Altering the review and approval process for participation and renewal in Track 1. It takes into account factors like an ACO’s history of compliance and quality performance over the first two years of program participation.
Beneficiary Assignment - Revising one step of the existing methodology of assigning beneficiaries to ACOs. It would remove certain specialty types whose services are not likely to be indicative of primary care services.
Data Sharing – Streamline the process for ACOs to access beneficiary claims data necessary for healthcare operations while retaining the opportunity for beneficiaries to decline to have their claims data shared with the ACO.
Establishing, updating and resetting ACO financial benchmarks – There are a number of possibilities here and comment is sought on all alternative methodologies for changing the benchmarks.
Encouraging ACOs to take on greater performance based risk – There is an opportunity to increase interest in performance risk-based options. This includes: adding Track 3 for ACOs to participate in the Shared Savings Program that has a higher sharing rate that Track 1 or 2; modifying Track 2 to increase attractiveness with a variable rate; and waiving certain FFS payment and regulations.
Eligibility requirements – Several small modifications are proposed which include requirements related to the agreement between ACOs and Medicare enrolled entities; governing body and leadership requirements; and a streamlined process to allow prior Pioneer ACOs to apply for program participation.
The 60-day public comment period is currently open and will run through February 6, 2015.
