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CMS issues proposed rule for ACOs
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The Centers for Medicare and Medicaid Services recently proposed new rules under the Patient Protection and Affordable Health Care Act for accountable care organizations.
Under the Medicare Shared Savings Program scheduled to begin Jan. 12, 2012, accountable care organizations (ACOs) that meet or exceed performance standards of care and decrease growth in heath care spending would be eligible to receive a share of the savings they make below individual benchmarks set by Centers for Medicare and Medicaid Services (CMS). According to a CMS fact sheet, patient and provider participation in an ACO is voluntary.
Potential requirements
According to provisions of the proposed rule, CMS-approved ACOs are responsible for self-assessment, monitoring and reporting of care. They must also accept responsibility for at least 5,000 Medicare beneficiaries and agree to participate in the Shared Savings Program for 3 years.
In addition to the possibility of being rewarded for meeting quality performance standards, the proposed rule calls for participating ACOs to repay Medicare for a portion of expenditures above their individual benchmarks.
CMS proposed that ACOs be assessed on 65 quality measures in the following domains of patient experience of care, patient safety, health of the frail and elderly/at-risk population, and preventative health.
Proposed eligibility requirements for an ACO include:
- ACO professionals in group practices;
- ACO networks of individual practices;
- hospitals with ACO professionals;
- joint ventures between ACO professionals and hospitals; and
- Medicare providers selected by the secretary of the Department of Health and Human Services.
CMS will accept public comments on the proposed rule until June 6, 2011.
Barriers to participation
Jeremy A. Lazarus, MD, a speaker for the AMA House of Delegates, noted that the association will review the proposed rule and looks forward to collaborating in the creation of physician-led models of patient care.
“ACOs offer great promise for improving care coordination and quality while reducing cost, but only if all physicians who wish to are able to lead and participate in them,” Lazarus stated in a press release. “For this to happen, significant barriers must be addressed, including the large capital requirements to fund an ACO and to make required changes to an individual physician’s practice, existing antitrust rules and conflicting federal policies.”
He added, “The AMA made recommendations to CMS on how to make it possible for physicians in all practice sizes and settings to successfully lead and participate in ACOs, including flexible requirements for ACO structure, transitional steps for ACO formation, increased access to loans and grants for small practices, easing of antitrust restrictions and timely access to quality data.”
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