ACO Final Rule

Academy Creates Summary to Help FPs Manage Information Overload on ACOs

November 09, 2011 04:55 pm News Staff

After carefully reviewing the recently released final rule on Medicare Accountable Care Organizations(www.gpo.gov), or ACOs, the AAFP has created a summary for members that winnows down the hundreds of pages in the rule to a 19-page version that provides a brief, but comprehensive, overview of the segments of the rule that could affect them.

The AAFP summary, "Medicare Shared Savings Program: Accountable Care Organizations Final Rule(19 page PDF)," is divided into 12 headings that cover information on such topics as historical background, ACO eligibility, structure and governance, shared savings methodology, quality measures, and the advanced payment model.

The summary also offers links to additional online materials, including eight tables that explain payment details, such as creation and use of quality performance standards for ACOs, a shared savings program overview, and the proposed minimum savings rate based on the number of assigned beneficiaries.

Academy Input Affects Final Rule

The summary also explains that the final rule looks very different from the proposed rule because it incorporates a number of changes suggested by the AAFP. For example, CMS accepted Academy recommendations to

  • HHS recently released the final rule on Medicare accountable aare organizations.
  • The AAFP has reviewed that document and created a 19-page summary of the final rule to help family physicians more easily manage the information.
  • The Academy supports the final rule, which includes many of the recommendations made by the AAFP.
  • eliminate the proposed retrospective beneficiary assignment method in favor of a preliminary prospective method that identifies beneficiaries quarterly;
  • reduce the number of individual quality measures used to determine ACO eligibility from 65 to 33;
  • provide quality reporting requirements for the second and third year of the program;
  • allow primary care physicians to participate in more than one ACO;
  • use a "pay for reporting" approach to quality reporting the first year;
  • phase in, over three years, the number of "pay for performance" measures used to calculate an ACO's performance score;
  • encourage use of electronic health records, or EHRs, by giving extra weight to a quality measure that looks at the percentage of physicians within an ACO who qualify for the EHR incentive program;
  • allow federally qualified health centers, rural health clinics and critical-access hospitals to participate;
  • give physicians access to upfront capital via an advanced payment program; and
  • offer multiple start dates within 2012.

Family Physician Participation

Participation in ACOs and Medicare shared savings programs is voluntary, but the Patient Protection and Affordable Care Act, which promulgates the ACO model, states that individual ACOs must include enough primary care professionals to care for the Medicare beneficiaries assigned to that ACO. In addition, an ACO must have an assignment of at least 5,000 Medicare beneficiaries, so the formation of any ACO is highly dependent on primary care professionals.

According to a statement by AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash., "The Medicare Accountable Care Organization final rule recently released by CMS represents a substantial step toward mending America's broken health care system. The final rule sets the stage for transforming the way patients receive care and promises to end the fragmentation, duplication and miscommunication that contribute to poor care and high costs."

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