CMS proposes changes to ACO structure under Medicare Shared Savings Program

The Centers for Medicare & Medicaid Services (CMS) has proposed a variety of changes to the payments to providers who participate in accountable care organizations (ACOs) under the Medicare Share Savings Program.

Among the biggest developments, CMS plans to use regional rather than national spending trends when updating performance benchmarks, it will also take into account the difference between fee-for-service spending in the ACO's regional service area and the ACO's historical spending.

"Medicare payments are an important catalyst to improving care delivery, spending our resources smarter and keeping people healthy," said CMS Acting Administrator Andrew Slavitt in a statement. "This proposal allows ACOs in all parts of the country to be successful by recognizing both their achievements and improvements in how they provide care. This should have the effect of growing the number of ACOs, and making ACOs and the coordinated care they provide to patients, more of a standard in all parts of the country."

Along with those changes, the agency has also proposed option and deferment years for ACO participants before making any changes to the way they're reimbursed (most ACO arrangements last for three years before there is a renewal or recalibration). It also proposed loosening the criteria for disputes over shared gains or shared losses as the result of an ACO's operation.

ACOs have borne some significant financial fruits, including a total savings to the Medicare program of more than $400 million in 2014. But few providers have received bonuses. Among the biggest fallouts as a result has been many providers pulling out of Medicare's other accountable care program: the Pioneer model.

To learn more:
- read the CMS proposed rule (.pdf)
- check out the CMS statement