Just one day after the forum, CMS issued its Medicare ACO proposed rule, making good on its own threats to do so in April.
The proposed rule, with comment due October 16, followed by a final rule, reduces the time allowed for ACOs to operate in an upside risk only structure from six to two years.
Also, financial rewards would fall from 50 percent to 25 percent while operating in a no-risk level. This is to push ACOs into a risk-bearing level, two-sided or downside risk. And many are doing so today. CMS added a perk to those within the Next Generation ACOs by adding telehealth originating site waivers for dermatology and ophthalmology.
That tide is already turning as into the 2019 Physician Fee Schedule proposed rule, CMS is implementing aspects of February’s Bipartisan Budget Act that expands telehealth for ESRD and stroke. The fee schedule goes further with other telehealth expansions though still bound by originating site until Congress and other Congressional bills further decrease originating site. The fee schedule also expands remote patient monitoring and introduces new codes for virtual check-ins and imaging movement.
The ACO proposed rule also mandates the use of the 2015 Edition of ONC certification, also seen in other of this summer’s CMS payment program rules. Industry reaction has been mixed, more sober than initial fears in April, which means it’s a positive sign for CMS’ proposed rule to remain largely intact toward a final rule.