It’s official—CMS’s final rule on accountable care organizations (ACOs) has entered the final stages of approval and should be released very soon.
The much-anticipated rule was sent to the Office of Management and Budgeton Oct. 5 as one of the last legislative step before being released in the Federal Register. If history proves true, the rule should be released within a week of reaching the OMB as it was with the latest e-Prescribing final rule.
ACO refresher: Top provider advocacy groups—namely the AMA, American College of Physicians (ACP), Medical Group Management Association (MGMA) and American Medical Group Association (AMGA)— sounded off this summer with major qualms regarding the proposed ACO rule saying that the requirements were too much for you and your peers (PBN 6/27/11).
Here’s a recap of their biggest concerns:
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Physicians risk savings and losses. The proposed rule offerred two tracks, one in which providers share losses in only the last year of the three-year ACO program, and a second in which providers share losses in all three years but gain a greater share of any savings generated (PBN 4/11/11). The ACP wants a third track where ACO participants only share savings, not losses.
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Low financial incentives. The proposed rule lets you share only in part of an ACO’s savings, and the provider groups want you to share in all savings. Remember: ACOs must save a minimum amount, based on their size, that is at least 2% less than the amount CMS calculates it would have paid under traditional fee-for-service (PBN 4/11/11). “CMS has made it extremely difficult for successful ACOs, particularly small ACOs, to obtain funding to cover the costs they incur in improving care,”
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Patient population variations. Patient population make-up should be evaluated annually since some populations may be much sicker or healthier than others and allow providers to reach out to their patients ahead of time to familiarize them with the ACO concept.
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Too much required reporting. The ACO proposed rule requires reporting 65 clinical quality measures—more than three times the number of stage 1 meaningful use measures you must report for electronic health records (EHRs). “The expectation is too high, except possibly for large, already integrated groups with substantial data gathering infrastructure already in operation,” the ACP said.