Home Health & Hospice

CMS finalizes Shared Savings ACO provisions

Homecare Insider, June 8, 2015

Last Thursday, CMS released a final rule that will update the Medicare Shared Savings Program—the most popular arm of the Accountable Care Organization (ACO) program—based on provisions proposed last December to boost quality service delivery to Medicare beneficiaries and provider participation in the collaborative care and payment model.  
“This final rule is an effort to provide support for the care provider community in creating a delivery system with better care, smarter spending, and healthier people,” CMS wrote in an email statement announcing the final rule, which will directly affect the more than 400 ACOs that are currently participating in the Shared Savings Program, as well as the more than seven million beneficiaries who receive care through these partnerships.
To realize its quality care, provider participation, and cost savings goals, the final rule emphasizes primary care and program flexibility. Specific highlights include:
  • Creation of a new track (Track 3) based on some of the successful features of the Pioneer ACO Model, which includes higher rates of shared savings, the prospective assignment of beneficiaries, and the opportunity to use new care coordination tools.
  • Establishment of a waiver for the three-day stay skilled nursing facility rule for beneficiaries who are prospectively assigned to ACOs under the new Track 3.
  • Streamlined data sharing between CMS and ACOs to help partnerships more easily and securely access data on their patients for quality improvement and care coordination.
  • Refinement of policies for resetting ACO benchmarks to propel patient care and cost savings. CMS intends to propose further improvements to benchmarking methodology later this year.
Activated by the Affordable Care Act, ACOs are intended to foster care coordination and collaboration among providers across the healthcare continuum to reduce growth in healthcare costs and improve care outcomes. ACOs become eligible to share savings with Medicare when they deliver services more efficiently while meeting or exceeding quality care benchmarks. 
More broadly, CMS characterizes ACOs as part of a growing initiative to cultivate “better care, smarter spending, and healthier people.” To that end, the Administration earlier this year announced the goal of tying 30% of Medicare payments to quality through alternative payment models, such as ACOs, by 2016 and 50% of these payments by 2018.
The final Shared Savings Program rule will be published in tomorrow’s Federal Register, accessible here. To access a PDF draft version of the document in the meantime, click here.
For more information on the Shared Savings Program, click here.
Beacon Institute members can read HCPro’s past ACO coverage in the December 8, 2014, issue of Homecare E-News and the May 2015 edition of Homecare DIRECTION. To learn more about Beacon Institute benefits, or to become a member, click here.