Joining an ACO Will Benefit Practices: CMS Outlines How

Going by the "shared savings program, accountable care organization (ACO) participants will collect a part of the amount the agency saves.

You have probably heard about Medicare's proposed 'shared savings program,' which will utilize ACOs to boost patient outcomes and bring down costs. However, that changed this week as the agency announced that it wrote a proposed rule for the program outlining what it'll cover.

What are ACOs?

ACOs aim to use coordinated care between health care providers to put the 'beneficiary and family at the center of care'. ACOs include several healthcare professionals who work together, including physicians, hospitals, and other members of the patient's care team. This 'case management' approach is meant to offer patient-centric care, thus resulting in better outcomes and lower costs.

As per the proposed rule, that appeared in the April 7 Federal Register, health care providers who participate in ACOs will be rewarded since Medicare will link payment rewards to patient outcomes. For example, the proposed rule notes that providers should be accountable for the cost of care, and be paid for reducing unnecessary expenditures and be responsible for excess expenditures.

Healthcare providers won't be required to join ACOs, however those who join will share the funds that CMS saves by using the system. Physicians will gather their portion of the shared savings as bonuses under the system. The ACOs are eligible to share in savings up to 52.5 percent under the one-sided model; however up to 65 percent under the two-sided model.

The one-sided model refers to a standard shared savings kind of plan in which ACOs wouldn't be responsible for any portion of the losses above the expenditure target. The agency recommends this model for "ACOs not immediately ready to accept risk, say for instance, physician-driven organizations and smaller ACOs, the proposed rule points to.

While the two-sided model explains a shared savings/losses plan, in which the ACO would share in savings and risk liability for any losses. All one-sided ACOs will mechanically become two-sided ACOs by the third year of the program.

ACOs would gather their bonuses based on how they meet 65 quality performance standard measures separated into the following five categories:

Patient/caregiver experience

Care coordination

Patient safety

Preventive health

At risk population/frail elderly health

You can submit comments on the ACO program through early June through email to www.regulations.gov or through the mail.