Lawmakers Introduce Legislation Aimed at Improving Medicare ACO Program

Dec. 8, 2017
U.S. Representatives Peter Welch (D-VT) and Rep. Diane Black (R-TN) have introduced H.R. 4580, the ACO Improvement Act of 2017 that makes changes to the Medicare accountable care organization (ACO) program.

U.S. Representatives Peter Welch (D-VT) and Rep. Diane Black (R-TN) have introduced H.R. 4580, the ACO Improvement Act of 2017 that makes changes to the Medicare accountable care organization (ACO) program.

Five leading healthcare organizations—The American Medical Association (AMA), AMGA, Medical Group Management Association (MGMA), National Association of ACOs (NAACOS) and Premier—support the legislation. Those organizations contend that the bill provides “sensible modifications to the Medicare Shared Savings Program (MSSP) to support the ability of ACOs to achieve success by reducing unnecessary costs, improving quality and enhancing patient outcomes.”

The bill makes operational changes that will promote coordinated healthcare and encourage Medicare ACOs to succeed and remain a strong value-based healthcare initiative for the nation’s senior citizens, the organizations said in a press release.

H.R. 4580 includes:

  • Waivers for all ACO tracks on cost-sharing for certain primary care services, and waivers for existing rules on telemedicine and remote monitoring
  • Three-day prior hospitalization waiver for skilled nursing facility services and waiver of the homebound requirement for 2-sided tracks
  • ACO choice of method for assigning beneficiaries
  • Bonus payments for quality achievement and for quality improvement
  • Improved methodology to better account for changes in patient health status over time

Clif Gaus, NAACOS president and CEO, said in a statement, “Signing this bill into law would strengthen ACOs in the Medicare Shared Savings Program and give physicians and clinicians more tools to provide better-coordinated care, resulting in improved quality standards and generating savings for the Medicare Trust Fund.”

“ACOs face a number of uphill battles today from antiquated policies and other complex variables,” Blair Childs, senior vice president of Public Affairs at Premier, said. “It’s critical that the Medicare Shared Savings Program urgently evolves to ensure the long-term success of its participants and the program overall, particularly as more providers pursue downside risk models. This is important legislation that helps to address some of the significant impediments for providers participating in ACOs, and we look forward to working with our health system members and Congress to get this bill passed and signed into law.”

Anders Gilberg, senior vice president, MGMA Government Affairs stated, “ACOs remain the single biggest opportunity for medical group practices to transition into Medicare alternative payment models. These common-sense reforms would go a long way towards ensuring success of medical groups in the Medicare ACO program.”

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