CMS Issues Final Accountable Care Organizations Rule

The final rules issued by Centre of Medicare & Medicaid Services (CMS) have provisions for implementing the “Shared Savings” program scheduled to start in 2012. This program awards accountable care organizations (ACOs) - integrated provider networks - with a portion of savings generated from more proficient care of assigned fee for service Medicare patients. Lately, CMS has also declared the first group of “pioneer” ACOs which will be entitled to a an increased share of savings and also an increased risk if there are inadequate cost savings, as compared to other ACOs.

Now, Medicare has made several concessions to garner more interest among both small and large provider groups. Some changes are good and favorable in terms of lessening the financial and administrative burden of forming an ACO. There are additional changes which will add more operational flexibility, like permitting other physician specialties to have greater effect on ACO performance. With these positive changes, it looks more feasible to either start a group from beginning or modify prevailing arrangements to qualify for ACO status.

Even though “pioneer” organizations are subject to somewhat different requirements, one can learn much from the initial selection process.