ACO Final Rules Not Exactly Hailed But Welcomed by Providers

Reform has certainly been controversial!

The Department of Health & Human Services (HHS) released the final rule for accountable care organizations (ACO).

According to Becker's, there are eight things you need to know.

1. Quality measurements are reduced from 65 to 33.
   
   This was done to appeal to more providers.


2. All ACOs must eventually transition into Track 2 models.
   
   Under Track 1, CMS and the ACO will reconcile savings and allow the ACO to share in those savings without the risk of the ACO sharing in any losses. ACOs can complete their initial agreement period on Track 1, but are then required to transition to Track 2. More experienced ACOs that are ready to share in losses with greater opportunity for reward could elect to immediately enter the two-sided model. An ACO participating in Track 2 would be eligible for higher sharing rates than would be available under the one-sided model.


3. The final rule eliminates barring ACOs with net losses from continued participation in the program.
   
   Underperforming ACOs can still participate but would be required to be accountable for their losses. The report says this rule was modified because barring ACOs that saw a net loss during their initial agreement period would "serve as a disincentive for ACO formation."


4. The requirement that healthcare providers use electronic health records to report quality measures has been eliminated.
   
   ACO participants can use survey-based measures, claims and administrative data based measures, and the group practice reporting options web interface as a means of ACO quality data reporting for certain measures.


5. Participants can only be part of a single ACO.
   
   Upholding its proposed rule, the agencies rule that physicians, hospitals and other providers can still only participate in one ACO if they have been assigned Medicare beneficiaries.


6. Retrospective assignment has been slightly modified.


7. CMS will use a "step-wise approach" as the basic assignment methodology.
   
   Beneficiaries will first be assigned to ACOs on the basis of utilization of primary care services provided by their PCPs. Beneficiaries who are not seeing a PCP may be assigned to an ACO based on primary care services provided by other physicians.


8. Governance is no longer required to be proportional to ownership.
   
   Additionally, ACO participants on the board are not required to have "proportionate control" of the ACO governing body in terms of ownership representation.

CMS estimates that ACOs could save Medicare up to $940 million from 2012 through 2015 versus the $2 trillion Medicare expects to spend during those four years, notes Kaiser Health News.

As we have reported, hospitals will lead the charge on forming an ACO. Then it becomes a matter of partnering with an ACO. But not everyone will be invited to the table. Big volume declines are expected and total costs of care are also expected to go down. You need to be positioned to attract hospitals as a care partner. That entails not just providing and measuring the clinical quality of care but also telling your story.

Learn more ~ or join the conversation!

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