CMS Administrator Don Berwick, MD, said the final rule for ACOs includes changes from the proposed rule that "create a more feasible and attractive on-ramp for a diverse set of providers and organizations to participate," according to his op-ed in the New England Journal of Medicine.
After the proposed rule was released March 31, Dr. Berwick said CMS received more than 1,200 formal comments. While most were supportive of the ACO vision, many wanted CMS to reduce the barriers to entry. Major changes reflected in the final rule, according to Dr. Berwick, include:
• Providing better and more timely information to ACOs at the outset of the performance year through preliminary prospective alignment of beneficiaries (while retaining a retrospective reconciliation to ensure that ACOs are measured on the basis of the patients they actually care for during the year);
• Retaining a strong monitoring and quality-measurement mechanism while streamlining the metrics to focus on what matters most, including reducing the total number of quality measures by about half;
• Allowing start-up ACOs to choose a "savings only" track without financial risk during their initial contract period;
• Sharing savings with successful ACOs on a "first dollar" basis when the ACO achieves meaningful savings for the Medicare program and improves care or provides high-quality care;
• Creating a pathway for full participation of federally qualified health centers and rural health clinics that provides a primary care safety net for Medicare beneficiaries in underserved areas.
He also said organizations not ready to develop an ACO have a menu of alternative options, including a comprehensive primary care program, bundled payments and a community-based transitional care program.
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After the proposed rule was released March 31, Dr. Berwick said CMS received more than 1,200 formal comments. While most were supportive of the ACO vision, many wanted CMS to reduce the barriers to entry. Major changes reflected in the final rule, according to Dr. Berwick, include:
• Providing better and more timely information to ACOs at the outset of the performance year through preliminary prospective alignment of beneficiaries (while retaining a retrospective reconciliation to ensure that ACOs are measured on the basis of the patients they actually care for during the year);
• Retaining a strong monitoring and quality-measurement mechanism while streamlining the metrics to focus on what matters most, including reducing the total number of quality measures by about half;
• Allowing start-up ACOs to choose a "savings only" track without financial risk during their initial contract period;
• Sharing savings with successful ACOs on a "first dollar" basis when the ACO achieves meaningful savings for the Medicare program and improves care or provides high-quality care;
• Creating a pathway for full participation of federally qualified health centers and rural health clinics that provides a primary care safety net for Medicare beneficiaries in underserved areas.
He also said organizations not ready to develop an ACO have a menu of alternative options, including a comprehensive primary care program, bundled payments and a community-based transitional care program.
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8 Things to Know About the ACO Final RuleACO Final Rule Released
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