Accountable Care Organizations

HHS Final Rule on Medicare ACOs Reflects AAFP Recommendations

October 26, 2011 04:05 pm News Staff

CMS released the final rule( on Medicare accountable care organizations, or ACOs, on Oct. 20, and the Academy's response quickly followed.

"Taken together with other initiatives, such as the Comprehensive Primary Care Initiative, the AAFP is optimistic that the Medicare ACOs will help move health care into a seamless, coordinated and responsive system that our patients deserve," said AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash., in a statement released on Oct. 21.

The Academy suggested a number of revisions to the proposed ACO rule in its May 20 comment letter to CMS Administrator Donald Berwick, M.D. The AAFP pushed for and got language that

  • gives primary care physicians the option to participate in multiple Medicare ACOs;
  • replaces the proposed retrospective beneficiary assignment method with a prospective assignment method in which beneficiaries are identified quarterly;
  • cuts the number of individual quality measures that will decide if an ACO qualifies for shared savings from 65 measures to 33 measures;
  • shares quality reporting requirements for the second and third years of the program; and
  • allows critical-access hospitals, federally qualified health centers and rural health clinics to participate in Medicare ACOs.
story highlights

  • CMS recently released the final rule on Medicare accountable care organizations, or ACOs.
  • In a statement from the Academy, AAFP President Glen Stream, M.D., M.B.I., noted that the Academy pushed for -- and got -- a number of significant changes in the final ACO rule.
  • CMS estimates that, as outlined in the final rule, the program could spur the creation of as many as 270 ACOs, or double the agency's estimate in the proposed regulation.

Stream said the final rule also gives family physicians in small to medium-sized practices additional time to make necessary adjustments in their administrative procedures and health record systems so that they, too, will be able to participate in ACOs.

He noted that Academy leaders and staff members are thoroughly reviewing the nearly 700-page document.

According to HHS' Oct. 20 news release(, ACOs -- in conjunction with other options soon to become available to health care professionals -- will help physicians deliver high-quality care with an eye toward more judicious use of health care dollars.

"Today, we have taken another step to improve health care for people with Medicare," said HHS Secretary Kathleen Sebelius in the news release. "We are excited to give doctors, hospitals and other providers the flexibility and support they need to work together and focus on making sure patients get the care they need."

Sebelius said the ACO model of care delivery might not work for everyone, but it would encourage health care professionals to collaborate in new ways.

In the same news release, HHS announced the launch of two new initiatives. The first is the Medicare Shared Savings Program ( will give health care professionals who band together to provide coordinated care for patients the opportunity to share in the savings they achieve for Medicare. Details on this program are embedded in the ACO final rule.

The second initiative, known as the Advance Payment ACO Model, will provide financial support to physician-owned practices and rural health care professionals who are participating in the shared savings program but need additional start-up resources to build the necessary infrastructure.

CMS estimates that the final rule could spur the creation of as many as 270 Medicare ACOs, or double the agency's estimate in the proposed regulation. The final rule on Medicare ACOs will be published in the Nov. 2 Federal Register.