Proposed ACO Regs Are Out!

“Patient centeredness,” “fragmentation” and “value based purchasing” are just a few of the terms that are peppered throughout the newly proposed regulations for accountable care organizations (“ACOs”).  The healthcare reform law established the Medicare Shared Savings Program for ACOs as a key way to accomplish its two core objectives:  (1) reduce healthcare costs, while (2) preserving and improving quality.  Like most new legislative ideas, the ACO regs raise lots of questions.

Who can become an ACO?

 Answer:  Pretty much any legal entity that complies with state law, has a tax ID number, applies successfully and which:

  1. Agrees to participate for three years;
  2. Cares for 5,000 Medicare patients;
  3. Is prepared to receive and distribute shared savings;

4.         Is prepared to repay shared losses (if it takes economic risk);

5.         Establishes reporting, and ensures ACO participant and ACO  provider/supplier compliance with program requirements, including the quality performance standards;

6.         Has shared governance that provides all ACO participants proportionate control over the ACO’s decision making process and includes Medicare patient representatives;

7.         Is operated and directed by Medicare-enrolled entities that directly provide health care services to Medicare patients.  ACO participants (e.g. physicians, hospitals) must have at least 75 percent control of the ACO’s governing body;

8.         Has sufficient primary care physicians to meet the primary care needs of the ACO patients;

9.         Has administrative and clinical organization and leadership;

10.       Is patient-centered though the use of such things as patient assessments and individualized care plans; and

11.       Is subject to substantial monitoring and reporting requirements, including public reporting of quality data to ensure transparency.

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