Final Rule Out on Medicare Shared Savings Program

The Centers for Medicare and Medicaid Services has released a final rule updating the Medicare Shared Savings Program to give providers greater flexibility and to grow their participation in the program.

According to CMS, the final rule is an effort to “provide support for the care provider community in creating a delivery system with better care, smarter spending, and healthier people.” Currently, more than 400 accountable care organizations are participating in the Medicare Shared Savings Program, with over 7 million beneficiaries. In November, CMS released early results indicating that Medicare Shared Savings Program ACOs in the first two years of the program improved quality of care for beneficiaries, with ACOs improving performance in 30 of 33 quality measures.

Also See: 89 ACOs Join Medicare Shared Savings Program in 2015

“Accountable Care Organizations have shown early but exciting progress in improving quality of care, while providing more patient-centered care at a lower cost,” said CMS Acting Administrator Andy Slavitt, adding that the final rule strengthens the agency’s “ability to reward better care and lay the groundwork for more providers to become successful ACOs.”

CMS made changes to its proposed rule after receiving public comments in response to a December 2014 Notice of Proposed Rulemaking. Enhancements to the final rule include:

*Creating 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;

*Streamlining 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;

*Establishing a waiver of the 3-day stay Skilled Nursing Facility (SNF) rule for beneficiaries that are prospectively assigned to ACOs under Track 3; and

*Refining 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. CMS also intends to propose further improvements to the benchmarking methodology later this year.  

In a written statement, the American Medical Association commended CMS for recognizing that there should not be a “one-size-fits-all” approach to ACOs in the agency’s new rules for the Medicare Shared Savings Program.

“Maintaining an ACO model that does not require repayment of financial losses will allow many physicians to gain experience analyzing data, improving care coordination and identifying opportunities to improve patient care while reducing spending,” said Robert M. Wah, M.D. AMA president.

“The AMA believes the ACO program will be most successful if physicians in each specialty can design and be paid in ways that give them the flexibility to deliver the best care for their patients and allow them to take accountability for the aspects of quality and spending they can manage,” added Wah. “We encourage CMS to accelerate efforts to accept and approve physician-designed alternative delivery and payment models in addition to its efforts to expand the ACO program.”

Additional information about the Medicare Shared Savings Program is available here.