News Feature | December 11, 2014

CMS Proposing Rule To Improve ACOs

Christine Kern

By Christine Kern, contributing writer


New rule reflects focus on primary care and improved incentives for participation, quality, and efficiency.

The Centers for Medicare and Medicaid Services (CMS) has released a proposal designed to strength the Shared Savings Program for ACOs by placing greater emphasis on primary care services and incentivizing transitions to performance-based risk arrangements, according to a press release.

The proposed rule reflects a focus on primary care and improved incentives for participation, quality, and efficiency, and it was crafted using input from experts, consumer groups, program participants, and the greater stakeholder community.

CMS Administrator Marilyn Tavenner explained in the release, “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 Medical Shared Savings program.”

A CMS fact sheet details the proposed changes which include providing more flexibility for ACOs in the renewal process; encouraging ACOs to assume greater performance-based risk and reward models; a greater emphasis on primary care; provision of alternative methodologies for establishing benchmarks; and streamlining data sharing and reducing administrative burdens.

The CMS statement explained, “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.”

Becker’s Hospital Review reports the proposal also includes the creation of “track 3,” a new two-sided risk model that would implement elements from the Pioneer program including higher rates of shared savings. CMS is also proposing streamlining ACOs access to Medicare beneficiaries' claims data necessary for quality improvement, while still maintaining beneficiaries’ right to decline to share claims information with the ACO.

CMS has announced that there will be a 60-day comment period on the proposed rule, which is available for viewing here. Comments may be submitted here. The Shares Savings Program provides care to more than 4.9 million beneficiaries through more than 330 ACOs in 47 states.