HHS Releases Final ACO Rule

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

The final version of the rule differs considerably from the proposed ACO rule released this past spring. Notably, it includes 33 quality measures rather than the 65 such measures included in the original and incorporates multiple start dates throughout 2012. Additionally, the use of electronic health records (EHRs) is no longer a requirement of ACO participation.

Two initiatives launched as part of the rule--the Medicare Shared Savings Program and the Advance Payment model –- are intended to aid providers in forming ACOs. The former will provide incentives to health care providers who providers who agree to work together and become accountable for coordinating care for patients. Providers who form partnerships under this model and who meet certain quality standards based upon, among other measures, patient outcomes and care coordination among the provider team, may share in the savings they achieve for the Medicare program; the higher the quality of care they deliver,
the more shared savings they may retain.

The Advance Payment Model may afford additional support to physician-owned and rural providers participating in the Medicare Shared Savings Program who also
would benefit from additional start-up resources to build the necessary infrastructure, such as new staff or information technology systems. Payments would be recovered from any future shared savingsachieved by the ACO.

Unlike a managed care plan, Medicare beneficiaries will, in line with the rule, not be locked into a restricted panel of providers. Rather, a determination of whether an ACO was responsible for coordinating care for a beneficiary will be based on whether that person received most of their primary care services from the organization.

“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,” Donald M. Berwick, MD, administrator of the Centers For Medicare and Medicaid
Services (CMS) said in a statement announcing the rule. “For example, the final rule will increase the incentives and streamline the Shared Savings Program, extending the benefits of the new program to a broader range of beneficiaries.”

The American College of Radiology (ACR) has yet to comment on the rule, but will do soduring the coming week, Spokesperson Shawn Farley says.

To read the final rule, click here: http://www.HealthCare.gov/law/resources/regulations/index.html.