New Rules! ACO Changes Mean More $$$ for Docs(?)

The Department of Health and Human Services has announced 2 new initiatives created under the Affordable Care Act that are designed to encourage primary care doctors, specialists, hospitals, and other healthcare providers to coordinate patient care under the umbrella of an Accountable Care Organization (ACO). The initiatives are designed to save Medicare beneficiaries money while increasing physician earnings through shared savings and advance-payment programs.

These new proposals would offer physicians additional savings and earning opportunities in conjunction with previously announced plans, such as the bundled payments and comprehensive primary care initiatives.

This is a voluntary program for improving care coordination across all healthcare settings. Under this proposal, ACOs that elect to become accountable for shared losses have the opportunity to share in greater savings. All Medicare providers can participate in an ACO to coordinate care, but only certain types of providers are able to sponsor one. Those providers include physicians in group practice arrangements, networks of individual practitioners, and hospitals that are partnering with or employ eligible physicians, nurse practitioners, physician assistants, and specialists.

The new rule will help organizations with less experience coordinating care, such as some physician organizations or small or rural providers, to gain experience before taking on the responsibility of sharing losses. It also allows more experienced providers to take on the responsibility of losses in exchange for greater potential rewards.

The Advance Payment Model tests whether advancing a portion of an 'ACO's future shared savings will increase participation from physician-owned and rural providers in the Medicare Shared Savings Program, and whether advance payments will allow those teams of providers to more quickly improve care for beneficiaries and generate Medicare savings.

This model is open only to physician-owned organizations, critical access hospitals, and rural providers participating in the Shared Savings Program.

This initiative will test 2 models for states to better align the financing of the Medicare and Medicaid programs and integrate primary, acute, behavioral health, long-term services, and supports for Medicare/Medicaid enrollees. For those states that are interested in testing these 2 models, CMS is offering streamlined approaches and technical assistance to support necessary planning activities

This demonstration, operated by the CMS Innovation Center and the Health Resources Services Administration (HRSA), will test the effectiveness of doctors and other health professionals working in teams to coordinate and improve care for up to 195,000 Medicare patients.