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Group representing ACOs asks for Shared Savings Program overhaul

Changes proposed by CMS to the Medicare Shared Savings Program that could also alter the future of accountable care organizations (ACOs) aren’t significant enough to satisfy a collection of healthcare provider groups.

The opposing group comprises provider healthcare improvement alliance Premier, Inc., the National Association of ACOs and the American Medical Association (AMA). Group members made several major suggestions to CMS, including that the agency:
• Provide medical specialists with the flexibility to take part in more than one ACO,
• Reward ACOs for quality performance
• Provide ACOs with more timely data

“The future of the ACO program is important to the future of Medicare and the health system as a whole. In just three years, physician-led ACOs have made a major impact on improving care coordination and quality while also reducing costs,” Robert M. Wah, M.D., president of the AMA, said in a release.

An AMA release — linking the organization to the larger group — reports Medicare ACOs have created more than $705 million in savings and more than 50% of ACOs in the Shared Savings Program reported savings in the first year. However, the savings haven’t totaled enough to provide ACOs immediate financial justification for their decision to join up, as only 25% have started regaining the money lost in changing over to a different care delivery model.

The group’s major theme of greater flexibility was exemplified by its assertion that ACO participants should receive waivers from some Medicare regulations that served as barriers to quality care. The group also said ACOs should be allowed to pick from a wider selection of payment models. It publicly disclosed its recommendations on Feb. 6 — the same day the 60-day public comment period on CMS’ proposal closed.

On Dec. 1, 2014, CMS released the proposed rule that aims to change some of the policies of the Shared Savings Program. The rule presented a few adjustments to encourage more providers to join an ACO, including removing a stipulation that required an ACO’s medical director to also be an ACO supplier/provider or someone who bills for Medicare services under an ACO participant taxpayer identification number.