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HHS announces new incentives for providers to coordinate care through ACOs
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A final rule issued by the Department of Health and Human Services has given physicians more options for the coordination of health care through accountable care organizations.
The rule, according to a Department of Health and Human Services (HHS) news release, will make it easier for physicians to provide better care while also allowing for a more efficient use of health care money. It includes two initiatives — the Medicare Shared Savings Program and the Advance Payment model — designed to help providers form accountable care organizations (ACOs).
“As a physician I understand the complexities of caring for a patient who may have multiple providers,” Centers for Medicare & Medicaid Services administrator Donald M. Berwick, MD, stated in the HHS release. “We listened very carefully to the more than 1,300 comments we received on the proposed rule released this spring, and this final rule includes a number of improvements suggested by those comments that will strengthen the program.”
Two new initiatives
The Medicare Shared Savings Program, according to the release, will provide incentives for participating health care providers who agree to work together and become accountable for coordinating care for patients. Providers who band together through the model and meet certain quality standards based upon — among other measures — patient outcomes and care coordination among the provider team will be able to share in the savings they achieve for the Medicare program.
The Advance Payment model will reportedly provide further support to physician-owned and rural providers who participate in the Medicare Shared Savings Program and would benefit from additional start-up resources needed for the setup of necessary infrastructure such as new staff or information technology systems. Advanced payments would be recovered from any future shared savings achieved by the accountable care organization.
New incentives for coordination
The programs, according to the release, create incentives for health care providers to work together in treating patient across multiple care settings.
Further changes noted in the rule include expanding the one-sided model to allow participation from rural health clinics and federally qualified health centers and organizations where specialists provide primary care — as well as the provision of a flexible starting date in 2012. Federal savings from this initiative, the HHS claimed in the release, could be up to $940 million over 4 years.
“We are pleased that the final rule on Medicare accountable care organizations includes many of the important changes recommended by the [American Medical Association (AMA)] to allow all interested physicians to lead and participate in these new models of care,” AMA president Peter W. Carmel, MD, stated in an AMA press release. “The AMA recommended that the risk and payment structure for potential ACOs should encourage participation by physicians in all practice sizes, and we are very pleased that this rule allows ACOs to share in every dollar of cost savings and includes an option that limits financial risk, which is important for many physician practices.”
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