ACO Final Rules Ease Requirements, Reduce Risk

Cheryl Clark, for HealthLeaders Media , October 20, 2011

"We've been able to fine tune and improve these rules to better meet the needs for a range of stakeholders, especially patient sand providers of care, no matter where they are on their spectrum of coordinated patient-centered care," Berwick said.

Because many providers complained that they lacked the considerable financial resources necessary to launch an ACO, CMS also released a new Advanced Payment Model for physician-owned and rural organizations to join, in which they would receive funds in advance that would be recouped from future savings in care provided down the road.

With an estimated 50 to 270 organizations participating in an ACO, the rule envisions a total aggregate median impact of $470 million in net federal savings for calendar years 2012 through 2015. Aggregated start-up investment costs are estimated at between $29 million to $157 million, with ongoing annual operating costs between $63 million and $342 million.

For fiscal year 2012, those organizations in the lowest performing percentile would receive $60 million in bonus payments while those in the 90th percentile would get $170 million.  By year 2015, bonus payments for those with the same percentiles of performance would receive $360 million to $740 million.

Among some of the other detailed changes from the proposed rules governing ACOs, also called the Medicare Shared Savings Program, are these:

 Instead of beneficiaries being retrospectively assigned to the ACO after the performance period, beneficiaries would be prospectively assigned and identified quarterly, with final reconciliation after each performance year based on which patients the ACO served.

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