Legislation introduced on Capitol Hill yesterday aims to reform the rules for accountable care organizations (ACO).
The ACO Improvement Act of 2016 was filed by U.S. Representatives Diane Black (R-Tenn.) and Peter Welch (D-Vt.) to update requirements and improve ACOs in the Medicare Shared Savings Program (MSSP). If passed, the bill would do the following:
- Encourage care coordination by allowing Track 1 ACOs the option of prospective attribution
- Reduce regulatory burdens for those ACOs by waiving the telehealth site-of-service requirements
- Encourage patient engagement by allowing those ACOs to waive cost sharing for primary care services
- Extend regulatory relief to Track 2 ACOs by waiving the Medicare three-day inpatient qualifying stay for the skilled nursing facility benefit and home health homebound requirements.
The American Medical Group Association (AMGA), a trade association focused on healthcare transformation, had advocated for the policy changes and applauded the new legislation.
“More than 100 AMGA members joined MSSP and they have improved care and reduced costs; however, they have struggled with outdated requirements,” said the group’s president and CEO Donald W. Fisher, Ph.D., in an announcement. “The suggested policy changes are a positive step that will improve the long term viability of the MSSP program.”
The ACO model is still in its infancy and has had its share of ups and downs, with varying opinions about organizations’ financial success. The latest data from the Centers for Medicare & Medicaid Services (CMS) shows ACOs in the MSSP had mixed to positive results. CMS in June released a rule to improve how Medicare pays MSSP ACOs to deliver better patient care and care coordination.