Final ACO Regulations Revealed Following Negative Feedback




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How does that saying go? If at first you don’t succeed, try again? Evidently, that is the prevailing theory in Washington as the Centers for Medicare and Medicaid Services (CMS) revised the protocol for Accountable Care Organizations (ACOs) following a backlash from healthcare professionals and providers.

In March, the CMS released the first set of guidelines for the ACO program. The skepticism and negative feedback was palpable. Healthcare providers, professionals, and organizations all questioned the feasibility of the plan. Among their complaints was the number of quality measures were far too many; the requirement to use electronic health records (HER) wasn’t realistic; financial terms weren’t attractive; and smaller physician groups would be at a financial disadvantage.

Under the new proposed changes, the number of quality measures was lowered from 65 to 33, the EHR percentage requirement was nixed and the risks associated with savings for cost-effectiveness were eliminated. Additionally, an advance-payment model for physician-owned ACOs will be offered, thereby lowering the financial burden many of the smaller facilities could face.

When the original ACO model was unveiled earlier this year, Somnia Anesthesia published a resource document that defined an Accountable Anesthesia Organization (AAO) model designed to align Somnia’s core business elements of increasing quality and reducing cost with the purpose and goals of the ACO model.

Hugh Morgan, Somnia’s director of quality assurance and a key contributor in creating the AAO model, was pleased with the latest changes to the ACO final ruling.

“No question that the initial ACO proposal was rather lengthy, complex and cumbersome at best,” says Morgan. “And although the final rule is still an almost 700 page document, the new guidelines are much less burdensome and restrictive for those who are considering voluntary participation in the initial ACO program. Even the final reportable quality metrics that were pared down from 65 to 33 are now in direct alignment with all of the currently reportable quality measures that exist in other regulatory programs.

“On the cost-savings side of the equation, it was clear that the original proposal had the potential for significant downside risk so the final rule has implemented various participation ‘tracks’ in which cautious ACOs can opt to participate in the shared savings, but not the shared losses in their particular ACO region. The overarching goal and likely result of the final ruling is to clearly entice more healthcare providers to view ACO participation as a good thing whereby the requirements are much clearer and straightforward and the risk upside is greater than the risk downside.” 

Somnia Anesthesia

Blog Editor

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