Moving Forward on ACOs

Today the Centers for Medicare & Medicaid Services (CMS) released the long-awaited final rule that will govern Accountable Care Organizations (ACOs). Established by the Affordable Care Act (ACA), ACOs create incentives for health care providers—doctors, nurses, hospitals and others—to work together to provide patient-centered care by organizing together in groups. The promise of ACOs is that by providing patient-centered, coordinated care, cutting down on duplications of tests, and preventing avoidable hospitalizations, the Medicare program will achieve savings while improving the quality of care patients receive. Providers who participate in ACOs that achieve these savings will be able to share in them.

While the final rule preserves certain aspects of the proposed rule, it does contain some significant changes. As was initially proposed, beneficiaries assigned to ACOs will still receive notice about participation and will not be locked in to a specific provider network. This means that beneficiaries who are assigned to an ACO will not be limited to using providers who are a part of that ACO, but may see any provider who participates in Medicare, as they do now. Among other changes from the proposed rule, the final rule reduces the number of reportable measures to assess quality by almost half, with a phase-in of additional measures over time. In addition, the rule expands the types of entities allowed to form an ACOto include Federally Qualified Health Centers and RuralHealthCenters.

Read the CMS press release on the final rule.

Read the CMS fact sheets on ACOs and the final rule.

Read the final rule.