CMS releases final, more physician-friendly rules for Medicare ACOs

CAL/AAEM News Service calaaem.news.service1 at gmail.com
Tue Nov 8 22:18:20 PST 2011


Description: Description: Description: Description: CAL/AAEM: California
Chapter of the American Academy of Emergency Medicine

October 31, 2011

 

CMS releases final, more physician-friendly rules for Medicare ACOs

 

cmanet.org <http://www.cmanet.org/cma-alert/archives/october-31-2011/#4> 

 

 

Responding to complaints from the California Medical Association (CMA),
American Medical Association and others in organized medicine, the Centers
for Medicare & Medicaid Services (CMS) released a final version of its
Medicare accountable care organization (ACO) regulations that seeks to be
more physician-friendly.

 

Although CMA has generally been supportive of the ACO concept, the draft
regulations issued earlier this year were burdensome and complicated and
would have made ACO participation either impossible or unattractive for both
large medical groups and small independent practices.

 

In June of this year, CMA urged CMS to modify several unworkable provisions
of its proposed regulations, including the requirement that physicians
accept financial risk. The earlier version of the regulations proposed a
two-track system that would have required ACOs to repay any expenditures
above the target benchmark. After preliminary review, it appears that the
final rule includes a number of positive changes that may make it more
attractive for California physicians to participate in ACOs.

 

In the final regulation, ACOs will be allowed to share in savings beginning
with the first dollar of savings earned. While there will still be two
different ACO tracks, one will be "upside only" during the three-year
contract period, i.e., the ACO will not be liable to pay CMS if expenditures
exceed the ACO's spending benchmark. The second track will give ACOs a
larger share of the savings if they also agree to share in the losses.

 

Other improvements include: a reduction in the number of quality measures
from 65 to 33; elimination of the Hospital Acquired Conditions measures;
removal of the requirement that 50 percent of an ACO's primary care
physicians need to be "meaningful users" of electronic health records; and a
slight improvement to the beneficiary assignment process.

 

Most significant, CMS has created a complementary program through the
Innovation Center to provide "advance payments" to physician organizations
and rural providers that do not have the capital reserves available to
finance the formation of an ACO or to cover short-term losses while waiting
to receive shared savings payments.

 

CMA is still reviewing the regulations and will provide additional details.

 

The final regulation is available from the Office of the Federal Register.

 

 

 

Marcus Williams &
Brian Potts MD, MBA
Managing Editors, CAL/AAEM News Service

 

 

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