Leaked Pioneer ACO draft proposal released

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A leaked copy of the Pioneer Accountable Care Organization (ACO) draft proposal from the Centers for Medicare & Medicaid Services (CMS) Innovation Center has been published on The Hill today.

As many speculated what the Shared Savings Program would hold, even more questions surrounded the accelerated Pioneer ACO program.

The unofficial draft proposal indicates that patient choice will remain intact for the ACO-aligned population.

"At all times, Medicare beneficiaries will remain free to select the providers and services of their choice. The Pioneer ACO payment model does not include any restrictions on or changes to Medicare fee‐for‐service benefits, nor does it include provisions for beneficiaries to opt out of alignment with an ACO for purposes of expenditure calculations and quality performance measurement," according to the 43-page document. "Any future possible provisions for beneficiaries to opt out of expenditure calculations and quality measurement will mirror those in the final regulations for the [Medicare Shared Savings Program]."

In addition, providers worried that particularly chronically ill patients might affect savings. The draft indicates that ACOs will able to place caps on certain patients.

"ACOs may elect to cap the expenditures incurred by an individual beneficiary to reduce the impact of beneficiaries who incur extraordinary claims on the average performance year expenditure of the ACO-aligned population."

In addition, various reference population trends will be factored in, including disability and age, for each performance year. Baseline expenditures will also change with each performance year and will be recalculated, an indication that CMS recognizes population changes from year to year.

A major criticism of the Pioneer ACO program from doubtfuls is the timing of the program. The draft specifies that Sept. 30 (two months away) will be the deadline for participants to identify the preliminary aligned population.

To learn more:
- nread the full Pioneer ACO draft (.pdf)
- read The Hill article

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