Press release: CMS releases new proposal to improve Accountable Care Organizations
- Date
- 2014-12-01
- Title
- CMS releases new proposal to improve Accountable Care Organizations
- For Immediate Release
- Monday, December 01, 2014
- Contact
- press@cms.hhs.gov
CMS releases new proposal to improve Accountable Care
Organizations
Shared Savings Program Proposed Rule reflects focus on
primary care and improved incentives for participation, quality, and
efficiency
The Centers for Medicare & Medicaid Services (CMS) today released a
proposal to strengthen the Shared Savings Program for Accountable Care
Organizations (ACOs) through a greater emphasis on primary care services and
promoting transitions to performance-based risk arrangements. The proposed rule
reflects input from program participants, experts, consumer groups, and the
stakeholder community at large. CMS is seeking to continue this important
dialogue to ensure that the Medicare
Shared Savings Program ACOs are
successful in providing seniors and people with disabilities with better care at
lower costs.
CMS Administrator Marilyn Tavenner said, gThis 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.h
Through the Affordable Care Act, ACOs encourage doctors,
hospitals and other health care providers to work together to better coordinate
care when people are sick and keep people healthy, which helps to reduce growth
in health care costs and improve outcomes. ACOs become eligible to share
savings with Medicare when they deliver that care more efficiently while meeting
or exceeding performance benchmarks for quality of care.
The Shared Savings Program now includes more than 330 ACOs in 47 states,
providing care to more than 4.9 million beneficiaries in Medicare fee for
service. Recently, CMS announced first year Shared Savings Program (SSP)
results:
- 58 SSP ACOs held spending below their benchmarks by a total of $705
million and earned shared savings payments of more than $315
million.
- Another 60 ACOs had expenditures below their benchmark, but not by a
sufficient amount to earn shared savings.
Other
Affordable Care Act initiatives to improve care and reduce costs have helped
reduce hospital readmissions in Medicare by nearly 10 percent between 2007 and
2013 – translating into 150,000 fewer readmissions – and quality improvements
have resulted in saving 15,000 lives and $4 billion in health spending during
2011 and 2012.
CMS is seeking comment on a number of adjustments to improve the Medicare
Shared Savings Program, including:
Providing more flexibility for ACOs
seeking to renew their participation in the Program. Many ACOs elect to
enter the Program under a one-sided risk model, where the organization
participates in shared savings with the Medicare program, but does not take on
additional performance-based risk. More experienced ACOs that are ready to share
in financial losses in return for the opportunity for a higher share of savings
may elect to enter a two-sided model. CMS is proposing to give ACOs the option
of a longer lead time to transition to a two-sided performance risk model after
their first agreement period. ACOs would have the opportunity to renew under the
one-sided model for one additional agreement period. ACOs that enter the Shared
Savings Program under the two-sided performance risk model would see no
change.
- Encouraging ACOs to take on greater performance-based risk and
reward. CMS is proposing to create a new two-sided risk model, called
gtrack 3,h which integrates some elements from the Pioneer ACO model, such as
higher rates of shared savings and prospective attribution of beneficiaries -
a list of assigned beneficiaries provided at the start of the performance
year, and no further beneficiaries will be added to the list during the
performance year.
We are seeking comments on a number of care coordination tools that would
make two-sided performance risk models more attractive to ACOs such as expanded
use of telehealth, beneficiary attestation, and more flexibility around
post-acute care referrals to help ACOs better coordinate care for beneficiaries
using these services. These tools could all help encourage participating
providers to improve quality and care coordination for Medicare beneficiaries,
which in turn would result in better patient experiences and greater shared
savings for both the ACO and the Medicare program.
- Emphasis on primary care. CMS proposes to refine the way Medicare
beneficiaries are assigned to an ACO to place greater emphasis on primary care
services delivered by nurse practitioners, physician assistants and clinical
nurse specialists and to allow certain specialists not associated with primary
care to participate in multiple ACOs.
- Alternative methodologies for benchmarks. CMS seeks comment on
alternative methodologies that would make ACO benchmarks for determining
shared savings and losses gradually more independent of the ACOfs past
performance and more dependent on the ACOfs success in being more cost
efficient relative to its local market. For example, we are considering
whether shared savings received by an ACO should be added back to the
benchmark in future performance periods
- .Streamlining data sharing and reducing administrative burden. CMS
proposes to streamline the process for ACOs to access beneficiary claims data
necessary for health care operations such as quality improvement activities
and care coordination while retaining the opportunity for beneficiaries to
decline to have their claims data shared with the ACO.
A fact sheet
with more information about the proposed rule is available at:
http://cms.gov/Newsroom/
The proposed rule will be open to a 60-day comment period. The proposed
rule is available for viewing at:
http://www.ofr.gov/(X(1)S(tofvuj12vvyo3oiwkp3jkln3))/inspection.aspx?AspxAutoDetectCookieSupport=1
Comments may be submitted at:
http://www.regulations.gov/
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