The final rule on Medicare accountable care organizations (ACOs) includes many of the recommendations that the American Medical Association (AMA), Pennsylvania Medical Society (PAMED), and others submitted in an effort to increase physician leadership and patient interaction.
Issued by the Centers for Medicare and Medicaid Services (CMS) on Oct. 20, 2011, the final rule is intended to improve the coordination of quality patient care for Medicare recipients while reducing overall health care costs.
The modifications to the proposed rule are intended to provide greater flexibility in eligibility to participate in the shared savings program, governance and legal structure of an ACO, timing for the evaluation of shared savings, antitrust review, and timing for repayment of losses.
Some of the highlights of the final rule include:
- Shared savings model will function as a pay-for-performance program based on total cost
- Program to provide advance payments to physician organizations and rural providers that do not have the necessary start-up funds
- Removal of requirements to withhold shared savings to cover potential future cost increases
- Number of quality measures reduced from 65 to 33, including removal of the hospital acquired conditions measures
- More prospective method of assigning beneficiaries whereby beneficiaries are assigned to ACOs at the beginning of the year
- Removal of requirement that 50 percent of primary care physicians in an ACO be “meaningful users” of electronic health records (EHRs) by program’s second year; weight of quality measure percent of providers who successfully qualify for an EHR incentive program doubled
- Community health centers and rural health clinics allowed to develop ACOs
- Rolling application process with multiple start-up dates—April 1, 2012, or July 1, 2012
- Clarification of anti-trust provisions of federal oversight and removal of mandatory review requirement
The AMA has issued this statement in response to the final rule.
CMS will begin accepting applications in Jan. 2012, with a three-year program commitment.