HHS releases final ACO rule with 'significant changes'

The Department of Health & Human Services (HHS) today released the final rule for accountable care organizations (ACO).

After much criticism from professional physician organizations and aversion from leading hospitals, HHS chopped the number of quality measures from 65 to 33, established multiple start dates throughout 2012, and eliminated the use of electronic health records as a requirement of participation.

In response to more than 1,200 formal comments, the Centers for Medicare & Medicaid Services (CMS) made "several significant changes" to the final rule to encourage doctors, clinics, and hospitals to coordinate their care, Administrator Dr. Donald Berwick wrote yesterday in a New England Journal of Medicine commentary.

"Taken together, these changes and numerous others create a more feasible and attractive on-ramp for a diverse set of providers and organizations to participate as ACOs," he said.

Among the changes, providers now will be able to participate in a "savings-only" ACO track without financial risk during the initial contract period, while community health centers and rural health clinics now can lead ACOs.

CMS estimates that ACOs could save Medicare up to $940 million from 2012 through 2015 versus the $2 trillion Medicare expects to spend during those four years, notes Kaiser Health News.

"The new rule is an easier pill to swallow, but still difficult for most systems to fully digest," Dan Mendelson, CEO of Washington-based consulting firm Avalere Health, said in a statement. "But fundamentally, most health systems continue to struggle with the fact that their present operations are oriented toward billing per service, and not taking on risk and responsibility for quality."

For more information:
- read the ACO final rule  (.pdf)
- read the Kaiser Health News article
-
read Berwick's commentary

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.