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CMS Finalizes Rule for Medicare Shared Savings Program and ACOs

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The Centers for Medicare and Medicaid Services (CMS) recently released a final rule updating the Medicare Shared Savings Program (MSSP), an initiative emerging from Section 3022 of the Affordable Care Act to promote better health for Medicare fee-for-service beneficiaries by encouraging health care providers to improve patient health and reduce costs. These latest changes to the program continue to encourage high-quality care for Medicare beneficiaries and build on the early successes of the program and of the Pioneer Accountable Care Organization (ACO) Model, but they focus on primary care services and add flexibility into the program.

Among many updates, the final rule:

  • Creates a new Track 3, based on some of the successful features of the Pioneer ACO Model, which includes higher rates of shared savings and risk (bonuses or penalties would be 75 percent of the ACOs savings or loss), the prospective assignment of beneficiaries, and the opportunity to use new care coordination tools;
  • Provides a three-year extension for Track 1 ACOs to take on no risk at all, though CMS has indicated that the the future success of the program relies on the two-sided risk model. (Originally Track 1 ACOs would have three years with the potential to earn bonuses, and thereafter would be subject to both penalties and bonuses depending on performance. This three year extension was provided for ACOs with high quality scores that are “in good standing with the program.”);
  • Streamlines the data sharing between CMS and ACOs, helping ACOs more easily access data on their patients in a secure way for quality improvement and care coordination that can drive critical improvements in beneficiaries’ care;
  • Establishes a waiver of the 3-day stay Skilled Nursing Facility (SNF) rule for beneficiaries that are prospectively assigned to ACOs under Track 3; and
  • Refines the policies for resetting ACO benchmarks to help ensure that the program continues to provide strong incentives for ACOs to improve patient care and generate cost savings, and announces CMS’ intent to propose further improvements to the benchmarking methodology later this year to account for regional payment differences and historically low Medicare per-beneficiary costs.

The MSSP, which began in 2012 with 27 ACOs, now boasts over 400 ACOs serving more than seven million beneficiaries. Over the last two years, ACOs have improved performance in 30 of 33 quality measures, and Pioneer ACOs generated over $384 million in savings to Medicare, according to an independent evaluation report released by CMS earlier this month. The MSSP is voluntary and accepts applications on an annual basis in which organizations agree to participate for three years.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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