CMS proposes rule for accountable care organizations

The Centers for Medicare and Medicaid Services recently proposed new rules under the Patient Protection and Affordable Care Act for accountable care organizations.

Under the Medicare Shared Savings Program scheduled to begin Jan. 1, 2012, an accountable care organization (ACO) that meets or exceeds performance standards of care and lowers growth in heath care spending would be eligible to receive a share of the savings below individual benchmarks set by CMS. According to a CMS fact sheet, patient and provider participation in an ACO is voluntary.

Under 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 at least 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 domains of patient experience of care, patient safety, health of the frail and elderly or 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.