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Major Changes in Medicare ACO Program Proposed

January 15, 2015


The Centers for Medicare & Medicaid Services (CMS) has proposed greater flexibility and potentially greater rewards for ACOs participating in Medicare’s Shared Savings program. Comments on the proposed changes, which would go into effect in 2016, are due by February 6, 2015.
 

CMS is seeking comments on several major changes:

 

  • Giving ACOs longer lead time in transitioning to a model in which they would share in financial losses, not just financial savings. Currently, ACOs in the Shared Savings program transition automatically to a shared savings/shared losses model after their initial three-year enrollment period. The new proposal would allow ACOs to participate in one additional three-year period in the savings-only model.
  • Encouraging ACOs to take on greater financial risk by offering them higher rates of shared savings and assigned beneficiaries. CMS proposes to create a new risk model, called Track 3, that would provide ACOs with greater rates of shared savings and a list of assigned beneficiaries at the start of the year, with no beneficiaries added during the performance year.
  • Encouraging primary care by nurse practitioners, physician assistants, and clinical nurse specialists. CMS proposes to refine the way Medicare beneficiaries are assigned to an ACO to place greater emphasis on primary care services delivery by this group of Medicare providers, and to allow certain specialists not associated with primary care to participate in multiple ACOs.
  • Relying more on the recent performance of ACOs, rather than their past performance, in calculating the amount of shared savings or losses. The CMS proposal would gradually make the benchmarks used in such calculations more dependent upon the ACO’s success in being more cost-efficient relative to its local market.