Overview
On October 20, 2011, the Department of Health and Human Services
(HHS) announced the establishment of a new voluntary Medicare Shared
Savings Program (MSSP) intended to give Medicare fee-for-service
beneficiaries the advantage of better coordination of care, and to make
patients and providers partners in care decisions. Created by the
Affordable Care Act (ACA), the MSSP, along with the Advance Payment model, will help providers form
Accountable Care Organizations. The proposed rule, released in
March, faced heavy criticism from the provider community, including SHM, due to its rigid structure and
burdensome requirements. CMS appears to have addressed most of this
criticism through a much improved final rule. Highlights of the
improvements made in the final rule include: - A single start
date (January 1, 2012) for all ACOs has been replaced by multiple start
dates in 2012 (April 1 and July 1)
- ACOs will be told which
Medicare beneficiaries are likely to be part of their system
(prospective attribution). Under the proposed rule, ACOs would not know
which patients were in the ACO until their contract ended (retrospective
attribution)
- Greater flexibility in the governance and legal
structure of an ACO
- No downside risk for ACOs choosing Track 1
and a share of first dollar savings for all ACOs achieving the minimum
savings rate
- The number of quality measures that ACOs will have
to meet to qualify for performance bonuses was reduced from 65 to
33
- Increased sharing caps
- Removal of the 25 percent
withhold of shared savings
- Greater flexibility in antitrust
review (applicants are no longer responsible for market share
calculations and antitrust review is now voluntary for all
applicants)
CMS has provided a chart directly comparing the proposed rule with
modifications to the final rule. It can be found here. The Advance Payment model will help
provide physician-owned and rural provider ACOs with up-front capital.
Under this initiative, CMS will distribute $170 million through the
Center for Medicare and Medicaid Innovation. ACO Final Rule
ACO Fact Sheets
Advanced Payment Model Solicitation
Antitrust Policy
Statement Summary of ACA ProvisionSection 3022 of the
ACA permits providers meeting certain criteria to be recognized as
Accountable Care Organizations (ACOs), beginning on January. 1, 2012,
and to qualify for a new shared savings program (provided they meet
certain quality thresholds). The ACA defines an ACO to include
specified groups of providers and suppliers who have an established
mechanism for shared governance. Eligible are ACO professionals in group
practice arrangements, networks of individual practices of ACO
professionals, partnerships or joint venture arrangements between
hospitals and ACO professionals, hospitals employing ACO, and other
groups of providers as determined by the Secretary. The ACO must
be willing to become accountable for the quality, cost, and overall care
of the Medicare fee-for-service beneficiaries assigned to it. An ACO
must participate in the program for at least 3 years and must include
primary care ACO professionals that are sufficient for the number of
Medicare fee-for-service beneficiaries assigned to the ACO. An ACO
shall have at least 5,000 beneficiaries assigned to it and must achieve
a certain minimum level of savings (to be determined by the Secretary)
before further savings is shared (with the Secretary authorized to
determine the percent of shared savings and establish limits on the
total amount of shared savings to be paid to an ACO).
The ACA authorizes the Secretary to use a partial capitation model or
any other payment model that will improve the quality and efficiency of
items and services furnished under Medicare. Under partial capitation, a
qualifying ACO would be at financial risk for some, but not all, of Part
A and B Services. The Secretary will have sole and final authority
over the following issues, which have yet to be determined: - The establishment of the quality performance standards and
the assessment of the ACO's performance against such
standards
- The assignment of Medicare fee-for-service
beneficiaries to the ACO
- The determination of whether an ACO is eligible for shared savings
or the amount of such shared savings—including the determination
of the estimated average per capita Medicare expenditures under the ACO
for Medicare fee-for-service beneficiaries assigned to the ACO, the
average benchmark for the ACO, the percent of shared savings, and any
limit on the total amount of shared savings
The
Congressional Budget Office (CBO) estimated that this shared savings
program will save Medicare $4.9 billion over FY2010-2019. Background MaterialMedicare Program Final Rule; Medicare Shared Savings
Program: Accountable Care Organizations
Final Rule released October 20, 2011 Final Waivers in Connection With the Shared Savings
Program
Joint CMS and Department of Health and Human Services Office of
Inspector General (OIG) Interim Final Rule with Comment Period
addressing waivers of certain fraud and abuse laws in connection with
the Shared Savings Program Affordable Care Act Gives Providers New Options to
Better Coordinate Healthcare
New ACO models will improve patient care and could save Medicare up to
$430 million Legislative Language From the Affordable Care
Act
Full text of the ACO provision SHM Submits Comments in Response to CMS Request for
Information Regarding Accountable Care Organizations and the Medicare
Shared Savings Program
Read the December 3, 2010
letter to CMS Administrator Berwick Accountable Care Organizations and the Medicare Shared
Savings Program
November 2010 Report from the Congressional Research Service
|
