Accountable Care News Oct 2011

Special Issue ACO Rule

Analysis of Key Changes from the Proposed Rule

By Epstein Becker & Green, PC

On October 20, 2011, the Centers for Medicare & Medicaid Services (“CMS”) released its Final Rule implementing the voluntary Medicare Shared Savings Program (“Program”) for accountable care organizations (“ACOs”), pursuant to Section 3022 of the Patient Protection and Affordable Care Act (“ACA”). The Final Rule was released in conjunction with revised guidance from the antitrust enforcement agencies, the Department of Health and Human Services’ Office of Inspector General (“OIG”), and the Internal Revenue Service (collectively the “Agencies”), as part of an inter-agency effort to facilitate participation in the Program.

 

The Program encourages the formation and operation of ACOs by promising to share Medicare’s savings from the program with those ACOs that: (1) meet eligibility requirements; and (2) meet the quality performance and Medicare cost savings targets described in the Final Rule.

By Daniel J. Marino, President / CEO of Health Directions, LLC - Commentary from National Thought Leaders

“The final Medicare Shared Savings Program Accountable Care Organization (ACO) regulations provide a better opportunity for organizations to succeed and manage their assigned population through the relaxed criteria. There are three significant areas that will positively affect organizations: care coordination, requirements around meaningful use and reliance on electronic health technology.


The most significant changes in the final ACO regulations are around the measures for establishing quality performance scoring. The final regulations move from 65 proposed measures to 33 final measures. They also limit the requirement around advanced care coordination across the patient’s care continuum. Initially, this was a major concern of many organizations since creating an advanced integrated technical infrastructure was very expensive, and in some cases cost prohibitive to organizations.

 

The final regulations appear to create a nice balance between driving care coordination around patient quality outcomes to reduce costs, and not overburdening organizations with significant new infrastructure investments.”