CMS/CMI Initiatives Related to ACOs
Three new initiatives relating to Accountable Care Organizations (ACOs) were recently released by the Centers for Medicare & Medicaid Services (CMS) and discussed May 17, 2011, during a conference call hosted by CMS Administrator Donald Berwick and Center for Medicare & Medicaid Innovation (CMI) Acting Director Richard Gilfillan.
1. Pioneer ACOs
The Pioneer ACOs Model will allow health care organizations and providers who are already experienced in coordinating care for patients across care settings to operate as an ACO to start early, even before the regulations are finalized and in effect. Pioneer ACOs will be expected to improve the health and experience of care for individuals, improve the health of populations, and reduce the rate of growth in health care spending. In return, they will be eligible to receive higher levels of shared savings than ACOs participating in the (regular) Shared Savings Program. CMS will publicly report the performance of Pioneer ACOs on quality metrics, including patient experience ratings, on its Web site. There will be an Open Door Forum to review the Pioneer ACO Model Request for Application on June 7, 2011. Providers interested in being pioneers must submit a letter of intent by June 10, 2011, and a formal application by July 18, 2011.
Pioneer ACO Request for Application, Letter of Intent, and Application: http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/pioneer-aco.
2. Accelerated Development Sessions for ACOs
CMI will hold free learning and assistance sessions for providers who want more information on how to form an ACO. A total of four sessions will be offered in 2011. Each will include a focused curriculum on core competencies for ACO development, such as improving care delivery to increase quality and reduce costs, using health information technology and data resources effectively, and building capacity to assume and manage financial risk. Participation in these sessions will not affect the CMS selection and approval process for ACOs.
Session Registration: https://acoregister.rti.org.
3. Advance Payments for ACOs
CMS recognizes that there are enormous startup costs for providers forming ACOs. The agency has estimated that the costs of startup and an initial year of management for an ACO will be $1.8 million, though the American Hospital Association recently announced that its research shows costs will run between $11.6 million and $26.1 million. Early feedback on the proposed ACO rule suggests to CMS that some providers lack ready access to the capital needed to invest in infrastructure and staff for care coordination. CMS is thus soliciting comments on its idea to pay out an advance on the shared savings that a new ACO is expected to earn to cover some front-end costs. New ACOs would need to provide a plan for using these funds. Comments are due June 17, 2011.
For more information on the Advance Payment Initiative, see: http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/advance-payment.
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ACOs are one mechanism established in the Accountable Care Act to improve the system of care under Medicare. An ACO is an umbrella organization made up of providers (combinations of hospitals, physician groups, and other health care facilities) that agree to be accountable for the quality, cost, and overall care of their assigned fee-for-service Medicare beneficiaries. Although the focus is on primary care, an ACO takes responsibility for a beneficiary’s entire continuum of care. The purpose of the program is to incentivize the provision of coordinated, quality care with better outcomes by sharing cost savings with providers. The proposed rule regarding ACOs was published in the Federal Register on April 7, 2011 (76 Fed. Reg. 19528) and AOTA submitted comments on June 6, 2011. AOTA continues to analyze the ACOs proposed rule and other CMS initiatives in order to determine therapy implications. Please e-mail us at rrpd@aota.org with your thoughts.
