The accountable care organization (ACO) final rule is here, and as the Centers for Medicare and Medicaid Services (CMS) sees it, the rule contains numerous concessions aimed at lowering the cost and risk burdens for those looking to participate in the Medicare Shared Savings Program.
Among the changes, listed nicely in an ACO final rule appendix, are the following:
- A reduction to 33 ACO quality measures, as opposed to 65 in the proposed ACO rule.
- The elimination of downside risk, which, as Healthcare Informatics points out, would have forced providers to pay back to Medicare the cost of unsuccessful savings efforts.
- Rolled-back start dates, with ACO agreements beginning April 1 or July 1, 2012 and program assessments comprising the remainder of 2012 and all of 2013.
- The dropping of electronic health record use as a condition of ACO participation (though EHR use remains a quality measure — and a highly weighted one at that).
- The inclusion of federally qualified health centers, critical-access hospitals and rural health clinics as ACO participants and leaders, along with an advanced payment model that will dole out $170 million to help those who qualify get a head start.
- A compromise on patient assignment that, as Healthcare Informatics notes, resembles the way it’s done in the “commercial sphere” while still giving patients a choice.
General reaction since the ACO final rule’s release on Oct. 20 has been positive. This isn’t surprising. Many experts said the ACO proposed rule was too strict and feared that its cumbersome IT requirements, complex application process, strict deadlines, excessive quality measures and high risk threshold would lead few organizations to actively participate.
With the relaxed ACO final rule in place, ACO participation should climb, according to Health Affairs. CMS actuaries say that up to 270 groups could form an ACO; this is twice what actuaries said after the proposed rule’s release. Such participation could bring 2 million Medicare patients into the ACO model, Kaiser Health News suggests.
CMS should receive the first round of ACO program applications in early 2012. By then the industry will have a better sense of whether the relaxed rules have made a difference.