CMS released its much-awaited final rule for Medicare accountable care organizations (ACOs), which is intended to renew interest in this integrated care model. ACOs have been hyped as one of the most promising new models of delivering healthcare by rewarding providers for rendering high quality care to Medicare beneficiaries, while keeping costs down. The proposed rule was issued with much fanfare in March, but it was roundly criticized by most provider groups for being too heavy on regulations and risk

The administration made several changes to the proposed rule that came out in March.  Among the key changes:

  • Providers will be able to participate in an ACO and share in savings with Medicare without risk of losing money. ACOs, will be able to start sharing in the savings earlier rather than letting Medicare retain all the initial savings.
  • The number of quality measures that ACOs will have to meet to qualify for performance bonuses was reduced from 65 to 33.
  • ACOs will be informed up-front which Medicare beneficiaries are likely to be part their system. Under the proposed rule, ACOs would not have known which patients were in the ACO until their contract ended.
  • Community health centers and rural health clinics will be allowed to lead ACOs.  They were left out of the proposed rule.

CMS also modified the timetable for the launch of the ACOs with groups allowed to apply throughout 2012.

The ACO final rule is set for publication in the November 2 Federal Register. In addition, CMS and the Department of Health and Human Services Office of Inspector General announced an interim final rule on waivers of fraud laws for ACOs. As part of the ACO announcement, antitrust regulators at the Department of Justice and Federal Trade Commission released an antitrust policy statement on ACOs.

The Internal Revenue Service also issued a fact sheet on tax-exempt organizations and ACOs at http://www.irs.gov/pub/irs-news/fs-11-11.pdf

CMS estimates that between 50 and 270 ACOs will be formed in the next three years, affecting the care of 2 million Medicare beneficiaries, or about 4 percent of beneficiaries.

To learn more about how you can become the provider of choice in the ACO collaboration, contact us at www.healthpro-rehab.com! We can discuss with you strategies on how you can improve your clinical outcomes and become appealing to your industry partners. 

Kate Davis is the director of business development at HealthPro Rehabilitation and can be reached at kdavis@healthpro-rehab.com.