Final ACO Regulations Issued - What Does this Mean?
After months of anticipation, today the Department of Health and Human Services (HHS) issued final regulations governing Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program established by the Patient Protection and Affordable Care Act of 2010. This news comes after preliminary ACO regulations were unveiled in April and the Centers for Medicare and Medicaid Services (CMS) was able to collect extensive feedback from provider organizations (such as the American Medical Group Association) and other stakeholders, many of whom criticized the program for being “overly prescriptive” and involving too much risk for providers, with not enough rewards.
The much anticipated final rules lessen the burden for healthcare providers and hospitals to participate in ACOs by decreasing required performance measures, eliminating the electronic healthcare record (EHR) requirement and removing financial risks for some to participate. It also eases the timetable to participate in an ACO and offers $170 million in incentives to physician-owned and rural providers to start ACOs.
ACOs are requiring hospitals, physicians and providers to “do more with less.” The objective is to entice these caregivers to adopt a new platform of service that creates integrated networks of physicians and hospitals to collaborate with one another, thereby sharing the responsibility of caring for patients and in doing so, improve outcomes and lower costs. If requirements are not met, this means lower Medicare payments. But if goals are met, bonuses are granted, rather than a fee-for-service payment, shared across entire networks. Fortunately, the final regulations appear to make achieving the end goal more tangible than previously anticipated. Nevertheless, doctors will still need to collaborate more than ever to provide coordinated care that will result in improved quality of care, better patient outcomes and cost savings.
While the 696 paged document detailing the final rules is thorough, an appendix of proposed rules verses final rules provides a great overview, as well as an article penned by Dr. Donald M. Berwick, the administrator for CMS. For example, the final rules now require 33 measures to assess quality (rather than an initially proposed 65) in 4 domains (instead of 5):
• Patient experience
• Care coordination and patient safety
• Preventive health
• Caring for at-risk populations
Some key provisions as outlined in the final rules:
• Providers can participate in an ACO and share in Medicare savings without risk of losing money
• Fewer quality measures that ACOs must meet
• Community health centers and rural health clinics now included
• Greater flexibility in antitrust review
Bottom line: With forecasted federal savings amounting up to $940 million over four years, providers who deliver higher quality of care and effective care coordination will be able to share in more savings.
Tags: accountable care, ACOs, Berwick, CMS, healthcare IT, healthcare reform, HHS, Medicare
Posted by Shannon Murphy on October 20, 2011 at 2:20 PM
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