Dive Brief:
- CMS is getting ready to issue final regulations for participation in Medicare's accountable care program; those regulations could affect whether or not hospitals and providers will continue to participate in the program.
- The new regulations could shrink incentives, change the way accountable care organization payments are caluculated and redefine which patients providers are responsible for.
- The proposed rule would lengthen the period of time before the requirement to take downside risk would kick in; those that choose to avoid risk would get a smaller portion of the savings they achieved for the Medicare program.
Dive Insight:
The wait for the final regulations has left ACOs in limbo. "I think they're all waiting; they're just as uncertain now as they were six months ago as to whether they will stay," Clif Gaus, CEO of the National Association of ACOs, told Modern Healthcare. "A whole lot is riding on the final rule and whether or not the ACO has a better chance of achieving savings and improving care."
Gaus said some of the things ACOs are hoping to see in the new regulations include a rule that allows providers to choose whether they want to identify their patients at the beginning or the end of the year, calculation of savings against regional medicare spending rather than national trends, exclusion of prior savings from the baseline used to calculate savings and waivers to Medicare rules for nursing home services.