Reprinted from ACO BUSINESS NEWS, a hard-hitting monthly newsletter on the latest industry actions to design and create ACOs, for hospitals, physicians, health plans and their advisers.
By Jennifer Lubell, Editor
June 2011Volume 2Issue 6
The National Committee for Quality Assurance tells ABN it will release final ACO accreditation standards in July “or soon thereafter,” and also will submit comments by the June 6 deadline on provisions in the draft Medicare Shared Savings Program regulations related to ACO quality metrics. An industry lawyer asserts that the recent issuance of the rule without any mention of NCQA accreditation calls the relevance of the private-sector organization’s forthcoming standards into question. But NCQA disputes that point — blaming it on timing and saying Medicare eventually may use its ACO accreditation.
Last fall, health care lawyers explained to ABN that nothing in the federal health reform statute grants NCQA any role to play in the accreditation process. Yet they acknowledged that NCQA had assembled a highly qualified group to set ACO standards and said that while NCQA lacks a government-sanctioned role, it could make an impact with its criteria (ABN 12/10, p. 8).
Included in that group was attorney Kathy Roe, a partner in the Chicago-based Health Law Consultancy, who said in November 2010 that using NCQA standards to accredit Medicare ACOs could provide a way to lift some of the burden off regulators — as long as the federal government thinks NCQA’s requirements are robust. But she said she didn’t expect CMS to publish a rule saying NCQA accreditation would suffice without seeing the final standards.
Roe now tells ABN that she doesn’t see any signs that CMS is looking at incorporating NCQA accreditation standards into its final rule on the Medicare Shared Savings Program. But she notes it is unknown how CMS may respond to public comments dealing with the accreditation issue.
“CMS didn’t really need to rely on [Medicare ACO] accreditation because in the proposed rule they draw from Medicare Parts C and D,” Roe explains. Given health care organizations’ publicly voiced concerns that proposed federal requirements are prescriptive and could prove challenging for many would-be ACO sponsors to meet, she adds: “At this point…for CMS to come back in and add accreditation I think would just pile on way too much for the industry.…I just don’t see the winds blowing that way right now. CMS spent a lot of time on the regs and drew a lot from existing programs.”
Whatever happens in this regard, Roe points out that NCQA’s year-long initiative to design ACO accreditation standards won’t be construed as an empty exercise. “If folks want a test run to see how they’re measuring up, certainly accreditation is the way to go,” she says. If organizations are successful in their efforts, she says, then NCQA’s stamp of approval could be used for marketing purposes in touting the ACO’s merits to group accounts and others. “ACOs could say they’ve passed muster with NCQA as well as CMS.”
Sarah Thomas, NCQA’s vice president of public policy and communications, tells ABN that NCQA’s forthcoming comment letter to CMS on the rule will “talk about the quality measures themselves and the data collection approach as well as the plan for benchmarking.”
Thomas says NCQA is hopeful that federal regulators ultimately will find it useful to deem certain requirements met if organizations go through NCQA’s accreditation process for ACOs — which she says wouldn’t be unprecedented since this occurred after the fact for Medicare Advantage plans. But she explains that NCQA hasn’t finalized its ACO program — and neither has Medicare — to show the degree of alignment needed for this to occur yet.
NCQA ‘Could Have Significance’
Thus, she says, NCQA wouldn’t expect its accreditation to be mentioned in the rule now — but it still could have significance later. She notes that NCQA’s “multi-cultural health care distinction program” was mentioned in the rule’s preamble, and she speculates that this occurred because CMS expects ACOs to reach out to diverse populations.
“We are going to make the case our program aligns with certain elements of CMS’s regulations, but neither program is final so it’s a little fluid at this point,” Thomas says. “We really do want to maximize the possibility that these organizations [i.e., ACOs] will be successful” in improving health outcomes, patient experience and the cost of care.
NCQA, a private, not-for-profit organization that accredits many health plans, wellness and health promotion programs, managed behavioral health care organizations and disease management programs, ended a public comment period on its draft ACO criteria last November that drew more than 2,200 recommendations from 220-plus organizations. NCQA proposes a set of core capabilities that entities should demonstrate at the outset — and every two to three years thereafter — to be recognized as ACOs. Its draft ACO standards fall into seven categories, ranging from program structure operations to performance reporting.
NCQA said April 18 that 10 organizations — four integrated health systems, four independent practice associations and two multi-specialty group practices — had successfully pilot-tested its ACO accreditation standards, thus clearing the way for the release of final standards. NCQA explained that the month-long pilot test — the final stage of a process that began in April 2010 — analyzed whether organizations could reasonably collect and submit information for the program.
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