Oct 202011

The U.S. Department of Health and Human Services published its 696 page rule on how accountable care organizations, the new medical care deilvery model, should structure themselves to qualify for reimbursement under the Affordable Care Act. The New England Journal published commentary by Don Berwick, current head of the Centers for Medicare and Medicaid, explaining the rule.

The Justice Department and Federal Trade Commission also issued a policy statement telling providers how to steer clear of antitrust law as they consolidate to become ACOs.

The new rule embodies changes demanded by medical care providers who rejected the initial rule and said they wouldn't participate:

  • No risk. ACOs get a share of the savings, but don't lose any money if they don't meet the goals.
  • Fewer requirements. CMS cut in half the number of quality measures that ACOs would have to meet, from 65 to 33.
  • Gaming OK for now. Under the original rule, ACOs would not know which of their beneficiaries were actually in the ACO until the contract ended, this "blinding" preventing preferential care. Under the new rule, providers will know up-front which of their patients are in the ACO (and can be sure those beneficiaries get every quality measure checked off).

ACOs could eventually represent a sea change in medical care delivery, but experts estimate that even with the new enticements, only 4% of Medicare patients will be part of an ACO in the next several years. The plan is hoped to save just under a billion dollars from CMS's budget over 4 years -- a fraction of the planned $2 trillion expenditures during that period.

Don Berwick: Making Good on ACOs' Promise — The Final Rule for the Medicare Shared Savings Program. N Engl J Med 2011; ePub October 20, 2011.

HHS Releases Final Regulations For ACOs (Kaiser Health News)

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Feds at HHS release final regulations for ACOs