The CMS is expected to issue final regulations soon that could significantly affect whether hospitals and doctors are willing to participate in Medicare's accountable care program.
The Medicare Shared Savings Program, which now includes more than 400 ACOs, offers financial incentives to hospitals and doctors for meeting cost and quality targets in serving defined groups of Medicare beneficiaries. The new regulations could change the amount of the incentives, how Medicare calculates savings, and which patients the hospitals and doctors are responsible for.
A draft version of the rule released last December included compromises designed to keep current ACOs in the program and lure more to participate. Under the rule, ACOs could stay in the program longer before they're required to accept the risk of penalties for not meeting targets. Those that choose to avoid downside risk, however, would not be able to keep as much of the savings they achieve.
An added lure to accepting downside risk is that ACOs would find out which patients they must manage at the start of the year, rather than at the end of the year.
Clif Gaus, CEO of the National Association of ACOs, said ACOs are “just as uncertain now as they were six months ago” whether they will stay in the program. “A whole lot is riding on the final rule and whether or not the ACO has a better chance of achieving savings and improving care.”
Gaus said ACOs want the CMS to calculate savings against regional Medicare spending rather than national trends, and to exclude prior savings from the baseline.