BREAKING: CMS Finalizes Medicare ACO Rule

June 5, 2015
The Centers for Medicare & Medicaid Services (CMS) has released a final rule updating the Medicare Shared Savings Program (MSSP), aiming to provide additional flexibility in the program with intent to increase participation.

The Centers for Medicare & Medicaid Services (CMS) has released a final rule updating the Medicare Shared Savings Program (MSSP), aiming to both enhance the focus on primary care services and provide additional flexibility in the program, with intent to increase participation. 

The final rule, according to a June 4 CMS press release, aims to encourage the delivery of high-quality care for Medicare beneficiaries and build on the early successes of the program and of the Pioneer accountable care organization (ACO) model. CMS is making these modifications to the proposed regulations after considering comments received from the December 2014 notice of proposed rulemaking (NPRM).

Some key takeaways of the final rule include:

  •  Refines the policies for resetting ACO benchmarks to help ensure that the program continues to provide strong incentives for ACOs to improve patient care and generate cost savings, and announces CMS’ intent to propose further improvements to the benchmarking methodology later this year.
  • Creates a new Track 3, based on some of the successful features of the Pioneer ACO Model, which includes higher rates of shared savings, the prospective assignment of beneficiaries, and the opportunity to use new care coordination tools;
  • Streamlines the data sharing between CMS and ACOs, helping ACOs more easily access data on their patients in a secure way for quality improvement and care coordination that can drive critical improvements in beneficiaries’ care;
  • Establishes a waiver of the 3-day stay skilled nursing facility (SNF) rule for beneficiaries that are prospectively assigned to ACOs under Track 3

More than 400 ACOs are participating in the Medicare Shared Savings Program, serving over 7 million beneficiaries. Early results released last November indicated the Medicare Shared Savings Program ACOs starting in the first two years of the program improved quality of care for beneficiaries, as ACOs improved performance in 30 of 33 quality measures.

What’s more, after two years in existence, the Pioneer ACO program has saved the Medicare program $384 million in total, or $300 per Medicare beneficiary per year. Participating providers saved Medicare $279.7 million in 2012 and $104.5 million in 2013, according to an independent evaluation report released by CMS in May.

“Accountable care organizations have shown early but exciting progress in improving quality of care, while providing more patient-centered care at a lower cost,” CMS Acting Administrator Andy Slavitt said in the press release.  “The ACO rules today strengthen our ability to reward better care and lay the groundwork for more providers to become successful ACOs.” 

Healthcare Informatics will keep you updated as this story continues to develop.

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