CMS Tweaks to ACO Investment Model Benefit Rural Physicians

July 01, 2015 02:05 pm News Staff

Back in 2011, HHS announced a proposed rule for accountable care organizations (ACOs) established as part of the Medicare Shared Savings Program, prompting the AAFP to weigh in with suggestions to improve the agency's proposal. In ensuing years, the federal government has continued to create and tweak various shared savings models to help improve the quality of health care in the United States while lowering cost.

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For example, in October 2014, CMS announced( the availability of a new initiative called the ACO Investment Model that is designed to better coordinate care to rural and underserved areas by providing as much as $114 million in upfront investments to as many as 75 ACOs around the country.

Most recently, CMS announced( two changes in the design of that model that could impact small group practices -- especially those in rural areas.

In a June 25 blog,( Patrick Conway, M.D., CMS Chief Medical Officer and deputy administrator for innovation and quality, described the recent rule modifications that

  • will allow ACOs that started in the Medicare Shared Savings Program in 2015 to apply to participate in the ACO Investment Model in the upcoming application round, and
  • will remove the "10,000 or fewer assigned beneficiary" investment model eligibility criteria for rural ACOs that started in the Medicare Shared Savings Program in 2015 (or will start in 2016).

"These two changes reflect the Innovation Center's commitment to listening to suggestions and ensuring that demonstrations are widespread," and include rural health care professionals and smaller physician groups, Conway said.

The application period for the investment model opens July 1.

According to CMS, the investment model( will test the use of prepaid shared savings to encourage new ACOs to form in rural and underserved areas and to encourage current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk.

CMS encourages health care professionals to participate in ACOs through the Medicare Shared Savings Program; the program creates financial incentives for ACOs that successfully hold the line or lower health care costs and meet quality performance standards.

The agency acknowledges that the investment model was developed in response to stakeholder concerns that some physicians don't have the financial resources available to invest in the infrastructure necessary to implement population care management.

CMS will provide financial support to those ACOs to enable them to make the necessary infrastructure investments and then develop innovative ways to improve health care for Medicare beneficiaries.

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