On Oct. 20, 2011, CMS released the final rule regulating the creation of Accountable Care Organizations (ACOs) under the Medicare Shared Saving Program. The purpose of ACOs is to help providers better coordinate care.
Other significant changes to the final rule include:
CMS also outlined an advanced payment model initiative developed by the Center for Medicare and Medicaid Innovation. The initiative will offer up-front payments to physician-owned and rural area providers aimed at helping defray the costs of forming an ACO.
- The one-sided risk model: A risk-free track for participating organizations. Participating providers will share only in profits — keeping up to 50 percent of cost savings — not losses for the full three years of the ACO agreement.
- The two-sided risk model: A risk-sharing track. Providers share up to 60 percent of cost savings but also share in any losses.
- A reduction in the number of quality measures that must be reported, from 65 to 33.
- An elimination of a mandate to meet stage one meaningful use criteria as set out in the EHR incentive program.
The AADA and other specialty groups provided comments on the proposed rule, stressing the importance of specialty care to the future of patient-centered managed health care. In response, CMS has indicated its intention to add an access to specialists module for care coordination. The AADA is seeking more information from CMS about when the module will be created and what it will entail.
The final rule took effect on Jan. 2, 2012.