The Centers for Medicare & Medicaid Services has released a factsheet on accountable care organizations for rural providers, sharing four specific provisions intended to increase rural participation in the Medicare Shared Savings program.
The following provisions are mentioned in the fact sheet:
1. ACOs in rural communities would be eligible for an exemption from the 2 percent net savings threshold. The Shared Savings Program proposed rule includes an exemption from the required 2 percent savings threshold under the one-sided model for ACOs with fewer than 10,000 assigned beneficiaries. ACOs of this size would be eligible to share in first dollar savings under if they meet one of the following criteria:
• The ACO is comprised only of ACO professionals in group practice arrangements or networks of individual practices of ACO professionals;
• At least 75 percent of the ACO's assigned beneficiaries reside in counties outside a Metropolitan Statistical Area;
• At least 50 percent of the ACO's assigned beneficiaries were assigned to the ACO on the basis of primary care services received from a critical access hospital;
• At least 50 percent of the beneficiaries assigned to the ACO had at least one encounter with an ACO participant federally qualified health center and/or rural healthcare centers in the most recent year for which data is available.
2. A lower confidence interval would be used to set the minimum savings rate for smaller ACOs. The proposed rule would offer an incentive to smaller ACOs to participate by using a lower confidence interval to set the minimum savings rate that must be exceeded in order to share savings related to larger ACOs.
3. Certain critical access hospitals would be eligible entities to form their own ACO. Certain groups of service providers, such as physicians and hospitals, and suppliers may form their own ACO as long as they meet the eligibility criteria, including minimum beneficiary assignment.
4. The proposal features incentives for including FQHCs and RHCs in the ACO. Federally qualified health center and/or rural healthcare centers may join an ACO as an ACO participant along with other organizations, but the assignment of beneficiaries would not be based on data from the FCHS and RHC. The incentives are an increase in the sharing rate.
Read the CMS fact sheet on rural providers and ACOs (pdf).
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The following provisions are mentioned in the fact sheet:
1. ACOs in rural communities would be eligible for an exemption from the 2 percent net savings threshold. The Shared Savings Program proposed rule includes an exemption from the required 2 percent savings threshold under the one-sided model for ACOs with fewer than 10,000 assigned beneficiaries. ACOs of this size would be eligible to share in first dollar savings under if they meet one of the following criteria:
• The ACO is comprised only of ACO professionals in group practice arrangements or networks of individual practices of ACO professionals;
• At least 75 percent of the ACO's assigned beneficiaries reside in counties outside a Metropolitan Statistical Area;
• At least 50 percent of the ACO's assigned beneficiaries were assigned to the ACO on the basis of primary care services received from a critical access hospital;
• At least 50 percent of the beneficiaries assigned to the ACO had at least one encounter with an ACO participant federally qualified health center and/or rural healthcare centers in the most recent year for which data is available.
2. A lower confidence interval would be used to set the minimum savings rate for smaller ACOs. The proposed rule would offer an incentive to smaller ACOs to participate by using a lower confidence interval to set the minimum savings rate that must be exceeded in order to share savings related to larger ACOs.
3. Certain critical access hospitals would be eligible entities to form their own ACO. Certain groups of service providers, such as physicians and hospitals, and suppliers may form their own ACO as long as they meet the eligibility criteria, including minimum beneficiary assignment.
4. The proposal features incentives for including FQHCs and RHCs in the ACO. Federally qualified health center and/or rural healthcare centers may join an ACO as an ACO participant along with other organizations, but the assignment of beneficiaries would not be based on data from the FCHS and RHC. The incentives are an increase in the sharing rate.
Read the CMS fact sheet on rural providers and ACOs (pdf).
Related Articles on ACOs:
Will Pioneer ACOs Come to the Rescue, or is the Government Rearranging Deck Chairs on the Titanic?
As Interest in ACOs Wanes, It's Time to Do the 'Next Right Thing'
7 Senators Ask CMS to Withdraw Proposed ACO Regulations