Final ACO rule brings health IT changes

By Government Health IT Staff
07:25 AM

The Centers for Medicare and Medicaid Services (CMS) issued a final rule late last week updating its Medicare Shared Savings Program (MSSP) to improve delivery of care for Medicare beneficiaries and build on the early implementations of the program and of the Pioneer Accountable Care Organization (ACO) model. 

CMS' MSSP final rule is aimed at enhancing primary care services and offering more flexibility in order to increase participation. CMS is making modifications to the proposed regulations after considering comments received from the December 2014 Notice of Proposed Rulemaking.

The CMS said the final rule aims to improve the program in a number of areas, including: creating a new ACO track based on some of the successful features of the Pioneer ACO Model; streamlining data sharing between CMS and ACOs to help ACOs more easily access data secure patient data; refining policies for resetting ACO benchmarks enable incentives for improving patient care and generating cost savings.

“Accountable Care Organizations have shown early but exciting progress in improving quality, while providing more patient-centered care at a lower cost,” said CMS Acting Administrator Andy Slavitt, in a news release.

“The [final] rules strengthen our ability to reward better care and lay the groundwork for more providers to become successful ACOs.”

The final rule also tells ACOs to outline in their application how they plan to implement technologies, which could include electronic health records, data aggregation and analytics tools, and electronic health information exchange.

Missing from the final rule? Previously proposed telemedicine waivers for ACOs in Track 1 of the program, according to iHealthBeat. Such waivers will be offered "starting as early as 2017," CMS said. Until then, CMS said it will consider telemedicine waivers from ACOs in two-sided risk models and those in Track 3 of the program.

The American Medical Association endorsed the final rule, noting that the flexibility will help doctors.
"AMA believes the ACO program will be most successful if physicians in each specialty can design and be paid in ways that give them the flexibility to deliver the best care for their patients and allow them to take accountability for the aspects of quality and spending they can manage," the AMA said in a statement. "We encourage CMS to accelerate efforts to accept and approve physician-designed alternative delivery and payment models in addition to its efforts to expand the ACO program."

ACOs are a part of the Department of Health and Human Services' broader plan to promote better care, more cautious spending, and improved health. The Obama Administration earlier this year announced the goal of tying 30 percent of Medicare payments to quality and value through alternative payment models, such as ACOs, by 2016 and 50 percent of payments by 2018. More than 400 ACOs are participating in the MSSP, serving over 7 million beneficiaries. Early reports showed ACOs improved performance in 30 of 33 quality measures.

The MSSP was created as part of the Affordable Care Act to promote better health for Medicare beneficiaries by encouraging physicians, hospitals, and other providers to improve patient health and experience of care and to cut costs.