5 key changes providers can expect from the new ACO rule proposal
When CMS unveiled its accountable care organization (ACO) program in 2011, it was met with trepidation from some healthcare providers, many of whom were uncomfortable with the parameters of risk and reward outlined in the program.
The proposed ACO rule issued last week aims to win the hearts of those on the fence about the program and keep hospitals and medical groups from dropping out. In a press release accompanying the proposal's unveiling, CMS said it hopes to strengthen the ACO shared savings program through "a greater emphasis on primary-care services and promoting transitions to performance-based risk arrangements."
Here are five of the rule's most important tenets:
1. A little bit more flexibility for medical groups…
Because so 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, 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 that enter the Medicare Shared Savings Program under the two-sided performance risk model would see no change.
2. … But there's a penalty for deferring risk.
While ACOs on track one would be able to extend their participation in this track for a second agreement period, and defer taking risk, there are strings attached. "They would also have to agree to taking a lower sharing rate for this agreement period," said Donald W. Fisher, president and CEO of the American Medical Group Association. "The financial penalty seems too extreme for taking this path."
3. An expansion of care-coordination tools.
CMS' proposal calls for expanding care-coordination tools risk-based ACOs can use, such as telehealth. But as Fisher notes, "these tools should be made available to all ACOs, not only those that are assuming risk," as all ACOs must make substantial investments to establish a successful program. It's been noted that under the new rule, the agency could issue a waiver of certain telemedicine requirements, such as those that require patients to be located in rural areas. "The telehealth proposal makes sense and is reasonable," Farzad Mostashari, the former ONC director whose company Aledade helps create and partner with ACOs, told Politico. "I'm not sure it will be a game changer for telehealth."
4. A data-sharing process that attempts to be more simplified.
CMS proposes to streamline the process for ACOs to access beneficiary claims data necessary for healthcare 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. However, the proposal would require beneficiaries to contact CMS directly with their preference, through an 800 number, Fisher points out. "This proposal does not necessarily reduce the current confusion around the issue, and would still require beneficiaries to take action," he notes.
5. More 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.
The public has until Feb. 6, 2015 to comment on the proposed rule.