Medicare final rule boosts ACO care coordination incentives

A new final rule will improve how Medicare pays accountable care organizations in the Medicare Shared Savings Program to deliver better patient care and care coordination. 

The Centers for Medicare & Medicaid Services said the final rule aims to help more ACOs participate in the Medicare Shared Savings Program by improving the payment methodology and providing them with a new participation option to move into the more advanced tracks of the program.

Under the final rule, Medicare will factor ACOs' ability to deliver higher-quality care at lower cost relative to other local providers into ACOs' reimbursements. Prior to the final rule, CMS based payment on the evaluation of an ACO's past performance.

The agency will also release yearly data reports on county-level risk scores and expenditures as well as ACO-specific data for the same counties, according to a CMS fact sheet.

CMS will also develop an option for ACOs in the first track to extend their participation for another year under the same terms before taking on more financial risk under the more advanced tracks. 

The agency said the changes will help build on the progress ACOs made in 2014, when they generated $411 million in total savings but few qualified for bonuses.

"Today's changes build on that progress, so that more patients benefit from coordinated care and Medicare pays for what works to help doctors, nurses, and other clinicians focus on the quality of care, not the quantity of services", said CMS in the announcement. The changes are also part of Medicare's broader strategy to "improve the healthcare system by paying providers for what works, unlocking healthcare data, and finding new ways to coordinate and integrate care to improve quality."

To learn more:
- read the final rule (.pdf)
- here's the announcement
- check out the fact sheet

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