JACKSON, Mich.--(BUSINESS WIRE)-- ABC is pleased that the Centers for Medicare and Medicaid Services (CMS) has made many physician- and patient-friendly changes in the final regulations on Accountable Care Organizations (ACOs), which were issued on October 20, 2011. The nearly 700-page document will take some time to analyze properly. Our initial impression is that the final version will help anesthesiologists and others who wish to launch ACOs, but there will still be roadblocks. The most significant of the obstacles is that ACOs are structured around primary care and do not expressly acknowledge the key role of specialty medical and surgical services.
Major Differences between the Proposed and the Final ACO Regulations
- Beneficiaries will be assigned to ACOs prospectively instead of retrospectively. ACOs will be notified in advance about the patients for whose cost and quality of care they are likely to be held accountable, with quarterly updates on the list of patients and feedback on the care they have received and retrospective reconciliation. This is clearly an area where the devil is in the details, but at least with prospective assignment physicians will know that the patient in front of them is one whose overall care they can and should help to manage within the structure of the ACO. Retrospective assignment offers no real behavioral incentive; indeed, it would seem to defeat the purpose of ACOs.
- ACOs may choose one of two incentive options. The One-Sided Model allows providers to share in the ACO’s savings (up to 50 percent); the Two-Sided Model allows greater shared savings (up to 60 percent) in exchange for sharing the risk of cost increases. Previously the One-Sided Model required a switch to risk-sharing in the third year. The final regulations do away with the potential penalty of the One-Sided Model.
- The potential bonus has increased. One-Sided Model ACOs will be able to share in savings beginning with the first dollar. In the proposed regulations, savings would only have been shared with the ACOs once a two percent threshold had been reached.
- CMS will not require a "withhold" of part of any shared savings. Under the previously proposed rule, 25 percent of the shared savings would have been withheld for a period of time. Not having the withhold will permit providers to receive more of their shared savings faster.
- The number of quality measures required to be reported has been reduced to 33 from 65 in the proposed rule. There will be a longer phase-in period, with payment for reporting on the measures during the first year and payment for both reporting and performance during the second and third years. The proposed rule limited payment for reporting to the first year only.
There will be a great deal to be learned about the application of the new rule to anesthesiologists, nurse anesthetists and anesthesiologist assistants as we study the ACO regulations in detail. For the full text of our preliminary communication to clients and supporters, please see our Alert at http://www.anesthesiallc.com/publications/ealerts/283-do-the-finalized-aco-regulations-help-anesthesiologists.
About Anesthesia Business Consultants
ABC, established in 1979, is one of the largest billing and practice management companies dedicated to the complex and intricate specialty of anesthesia and pain management. It is both an American Society of Anesthesiologists Practice Management Supporter, and an Anesthesia Quality Institute Preferred Vendor. ABC employs industry leaders, operates under proven efficient processes, and utilizes technology advances to easily adapt to the ever-changing regulatory environment.
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