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CMS seeks comments on proposed rule for ACO program

Accountable care organizations are on the verge of receiving a supportive push from the Centers for Medicare and Medicaid Services (CMS) to aid them in their mission of improving the quality of care coordination while reducing expenses.

CMS recently issued a proposed rule that aims to improve policies of the Medicare Shared Savings Program (SSP). The rule would make changes to several areas of the program including:

  • Providing more flexibility for ACOs seeking to renew their participation in the program and modifications to eligibility requirements
  • Encouraging ACOs to take greater performance-based risks
  • Streamlining data sharing process to simplify administrative processes
  • Establishing, updating and resetting financial benchmarks
  • And emphasizing primary care

The rule was put together with input from program participants, experts, consumer groups and other stakeholders. Currently, the SSP includes more than 330 ACOs. There are more than 125,000 practitioners enrolled in the Medicare program and roughly 4.9 million beneficiaries assigned to ACOs.

“This proposed rule is part of our continued commitment to rewarding value and care coordination — rather than volume and care duplication. We look forward to partnering with providers and stakeholders to continuously refine and improve the Medicare Shared Savings program,” said CMS Administrator Marilyn Tavenner.

Through the SSP, established by the Affordable Care Act, ACOs that succeed in providing better, more affordable care by avoiding unnecessary duplication of services and preventing medical errors receive a percentage of the savings achieved. Among the first year SSP results announced by CMS, 58 ACOs held spending below their benchmark figures by a total of $705 million and earned shared saving payments of more than $315 million. In addition, 60 ACOs had expenses below their benchmark, but their expenses weren’t low enough to receive shared savings.

CMS is seeking comments on the proposed adjustments aiming improve ACOs through the SSP. The comment period will close on Feb. 6, 2014.

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