The Latest on the ACO Final Rule

The Latest on the ACO Final Rule

The Centers for Medicare and Medicaid Services has sent a Shared Savings/Accountable Care Organizations final rule to the Office of Management and Budget (OMB) for review. OMB review is one of the last steps before the publication of a rule in the Federal Register.

The rule would establish the Medicare Shared Savings Program authorized in the health reform law. Under Shared Savings, provider organizations are encouraged to form accountable care organizations to tightly coordinate the care of chronically ill patients across the continuum of care, and to share in the savings that may result.

Industry concerns raised during the comment period on the proposed rule included:

* The proposed set of 65 measures would be too burdensome for newly formed accountable care organizations and should be cut in half;

* The threshold for providers to share in savings, at least 2 percent above the benchmark, has been difficult to achieve in earlier pilot programs;

* A final rule should include an option allowing ACOs to receive shared savings without the downside risk;

* Giving patients enrolled in an ACO the ability to restrict access to their health information could compromise an ACO's ability to improve individual health;

* The definition of eligible physicians should expand to include pathologists and laboratory professionals; and

* Requiring 50 percent of participating primary care physicians to demonstrate meaningful use of electronic health records by their second year could reduce interest in the program and should be cut to 25 percent.