Although released later than initially expected, the Department of Health & Human Services (HHS) on Thursday finally delivered its final rule for accountable care organizations (ACO) with the goal of saving Medicare $940 million over four years. Now that the near 700-page standards are out--apparently as a more relaxed version--will it win over any providers who initially shunned the proposed rules back in March?
The ACO regulation, under the Accountable Care Act, is a ground-breaking final rule that could change the traditional fee-for-service payment method to pay for performance, in which quality would be rewarded over quantity. With aims to connect hospitals, primary care physicians, specialists, and other providers all together (for those who choose to opt into the voluntary program), the Centers for Medicare & Medicaid Services (CMS) offers a reimbursement reward system for providers (individuals and organizations) that coordinate care for better patient outcomes and cost savings. Essentially, it's an incentive plan for the touted "the right care at the right time" mantra, as noted in the ACO FAQ webpage.
"These new final rules, which were made final after an extensive review of comments and additional stakeholder input on the proposed rule, add a new option for providers looking for support in coordinating patient care," states the Heathcare.gov website. Extensive review? No kidding. After unveiling the first set of proposed rules in the spring, CMS received 1,320 comments, many of which contained criticisms that the initial rules were too burdensome and too prescriptive and dissuaded even the leading hospitals from partaking in what they saw as a risky experiment.
"We listened very carefully... ," CMS Administrator Dr. Don Berwick said, "and this final rule includes a number of improvements suggested by those comments that will strengthen the program."
Brevity is not the government's M.O. Here's the breakdown of some important changes in the final rule (694 pages to be exact) from the proposed rule aimed at attracting more participants and easing the standards.
"In this final rule we have made significant modifications to reduce burden and cost for participating ACOs." They are:
- More flexibility in eligibility to participate in Shared Savings Program
- Multiple start dates in 2012
- A longer agreement period for those starting in 2012
- More flexible governance and legal structure of an ACO
- Simpler quality performance standards from the proposed 65 to the final 33 quality measures
- Adjusted financial risk model
- Higher sharing caps
- No down-side risk for some participants
- Removal of the 25 percent withhold of shared savings
- Flexible antitrust review
- Flexible repayment of losses
- Inclusion of federally qualified health centers and rural health clinics to participate and form independent ACOs
Called a "menu of options for providers looking to better coordinate care," according to the HHS press release, providers also can elect other programs outside of Shared Savings.
HHS Secretary Kathleen Sebelius recognized that even with the changes, the Shared Savings program might not fit all providers.
"This model of delivering care may not be right for everyone, but it provides new incentives for doctors, hospitals, and other health care providers to work together in new ways," said Sebelius in the press release.
The real question is, now that CMS has relaxed the rules, will the big names (Cleveland Clinic, Mayo Clinic, Geisinger Health System, and Intermountain Healthcare) be enticed to choose from HHS' menu? We'll all be listening for their reactions. - Karen (@FierceHealth)