CMS Proposes New Rule To Drive ACO Participation

The Centers for Medicare & Medicaid Services (CMS) proposed a new rule Monday that aims to boost Accountable Care Organization (ACO) success by improving incentives to participate. 

The changes would update and improve policies governing the Medicare Shared Savings Program (Shared Savings Program) by targeting several program areas including beneficiary assignment, data sharing, available risk models, eligibility requirements, participation agreement renewals and compliance and monitoring.

The proposed rule is part of CMS’ effort to ensure that Medicare Shared Savings Program ACOs are successful in providing seniors and people with disabilities with better care at lower costs, the federal agency says in the proposed rule’s announcement.

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, the agency says, adding that 58 Shared Savings Program ACOs held spending below their benchmarks by a total of $705 million and earned shared savings payments of more than $315 million in the first year of the program.

In addition, another 60 ACOs had expenditures below their benchmark, but not by a sufficient amount to earn shared savings, according to first year results.

“This proposed rule is part of our continued commitment to rewarding value and care coordination – rather than volume and care duplication,” says CMS Administrator Marilyn Tavenner in a statement. “We look forward to partnering with providers and stakeholders to continuously refine and improve the Medicare Shared Savings program.”

The proposed rule will be open to a 60-day comment period.

Access the proposed rule here, and a CMS fact sheet about the proposed changes here.

Written by Cassandra Dowell

Cassandra Dowell

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