CMS NEWS
FOR IMMEDIATE RELEASE
January 28, 2016
Contact: CMS
Media Relations
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CMS Announces Proposed
Improvements to Medicare Shared Savings Program
Plan Strengthens Incentives for
ACOs to Improve Performance
The Centers for Medicare & Medicaid Services (CMS) today released a
proposed rule to update the methodology used to measure the performance of
Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program
(Shared Savings Program). Today’s proposal builds on the momentum of growth in
the Shared Savings Program and charts a path for long-term sustainability by
improving the long-term incentives for ACOs as they continue to provide
efficient, high quality health care to Medicare beneficiaries.
"Medicare payments are an important
catalyst to improving care delivery, spending our resources smarter and keeping
people healthy," said Andy Slavitt, Acting Administrator for CMS.
"This proposal allows ACOs in all parts of the country to be successful by
recognizing both their achievements and improvements in how they provide care.
This should have the effect of growing the number of ACOs, and making ACOs and
the coordinated care they provide to patients, more of a standard in all parts
of the country."
Under
the proposed rule, CMS would modify the process for resetting the benchmarks,
which are used to determine ACO performance for ACOs renewing their
participation agreements for a second or subsequent agreement period. The
proposed methodology would incorporate factors based on regional
fee-for-service expenditures, into establishing and updating the ACO’s rebased
historical benchmark, including an adjustment to the benchmark based on
regional spending that is phased-in over several agreement periods.
Key
proposals include:
- Recognizing that health cost trends vary in communities
across the country by using regional, rather than national, spending
growth trends when establishing and updating an ACO’s rebased benchmark.
- Adjusting an ACO’s rebased benchmark when it enters a
second or subsequent agreement period by a percentage (increased over
time) of the difference between fee-for-service
- spending in the ACO’s regional service area and
the ACO’s historical spending, which will provide a greater incentive for
continued ACO participation and improvement.
- Giving ACOs time to prepare for benchmarks that
incorporate regional expenditures by using a phased-in approach to
implementation.
Other changes would include:
- Adding a participation option to facilitate an ACO’s
transition to performance-based risk arrangements by allowing eligible
ACOs to elect a fourth year under their existing first agreement and defer
by one year entering a second agreement period under a performance-based
risk track.
- Streamlining the methodology for adjusting an ACO’s
benchmark when its composition changes.
- Clarifying the timeline and other criteria for
reopening determinations of ACO shared savings and shared losses for good
cause or fraud or similar fault.
Today’s proposals are the product of extensive stakeholder input. CMS
sought comment on the methodology used to reset ACO benchmarks in a proposed
rule released in December 2014. In June 2015, CMS indicated that it would
pursue future rulemaking on this issue.
A fact sheet with more information about the proposed rule is available
at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-01-28-2.html
The proposed rule will be open to a 60-day comment period. The proposed
rule is available for viewing at: https://www.federalregister.gov/public-inspection
Comments may be submitted by March 28, 2016 at: http://www.regulations.gov/
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