Accountable Care Organizations Hate Medicare’s Final ACO Rule

Confident DoctorsLast Thursday, the Centers for Medicare & Medicaid Services published the final rule for Medicare Shared Savings Program Accountable Care Organizations (MSSP ACOs). At almost 600 pages, it differs in many ways from the proposed rule issued last December:

  • Creates a new Track 3, based on some of the successful features of the Pioneer ACO Model, which includes higher rates of shared savings, the prospective assignment of beneficiaries, and the opportunity to use new care coordination tools;
  • Streamlines the data sharing between CMS and ACOs, helping ACOs more easily access data on their patients in a secure way for quality improvement and care coordination that can drive critical improvements in beneficiaries’ care;
  • Establishes a waiver of the 3-day stay Skilled Nursing Facility (SNF) rule for beneficiaries that are prospectively assigned to ACOs under Track 3; and
  • Refines the policies for resetting ACO benchmarks to help ensure that the program continues to provide strong incentives for ACOs to improve patient care and generate cost savings, and announces CMS’ intent to propose further improvements to the benchmarking methodology later this year.

“Successful features of the Pioneer ACO model”? That’ll be a struggle. As we’ve discussed, the Pioneer ACOs have had very meager results, and will probably end up as a footnote to Medicare’s history.

MSSP ACOs differ in many ways from Pioneer ACOs, and it is too early to tell what their results will be. It’s not too early to tell how the ACOs themselves are reacting to the final rule:

Federal officials are making a high-stakes gamble with Medicare’s popular shared savings program designed to encourage health systems, hospitals, and physician groups to assume more financial risk in treating patients, healthcare providers say.

Providers are bracing for a bumpy ride in the drive to quicken adoption of value-based payment at Medicare. (Christopher Cheney, “MSSP Final Rule Panned by Providers,” HealthLeaders Media, June 8, 2015)


Despite the Obama administration’s efforts to retain and attract participation in the Medicare Shared Savings Program for accountable care organizations, some may walk away because the agency failed to budge on some of their concerns.  (Virgil Dickson, “ACOs say Medicare rule doesn’t bend far enough,” Modern Healthcare, June 5, 2015)


……  the National Association of ACOs, or NAACOS, also praised the decision regarding the so-called one-sided model, known as Track 1, while criticizing CMS for failing to make other requested changes. Some groups said they wanted to see a voluntary policy for assigning beneficiaries to ACOs. Additional adjustments could have helped make it more attractive for medical offices to advance to the Tracks 2 and 3 of the ACO program, said Clif Gaus, chief executive officer of NAACOS, in a statement.

“I remain skeptical that enough improvements have been made to Track 1 to sustain the growth we have been seeing and am concerned that large numbers of current ACOs are not ready to take on the higher risks” of Tracks 2 and 3, he said. (Kerry Young, “Groups Support Change in Key Medicare Payment Overhaul Program,” CQ Roll Call, June 5, 2015)

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