On Thursday, October 20, 2011, the United States Department of Health and Human Services released its final regulations for accountable care organizations (“ACOs”). As you may recall, the primary goals of ACOs are to realize cost savings and improve quality of care by encouraging primary care physicians, specialists, hospitals, and other health care providers to coordinate their care for Medicare fee-for-service beneficiaries and commercially-insured patients.

In our prior ACO Primer posts discussing the proposed ACO regulations, we analyzed some of the important regulatory and operational aspects of forming and operating a successful ACO. The recently-released ACO final regulations contain a number of changes that were implemented in response to comments from the private sector. Highlights of the changes include the following:

  • Removing two-sided risk from Track 1 of the Medicare Shared Savings Program (“MSSP”).
  • Adopting a preliminary prospective-assignment method with beneficiaries identified quarterly, and a final reconciliation after each performance year based on patients served by the ACO.
  • Reducing the number of measures to assess quality to 33 measures in 4 domains.
  • Implementing longer phase-in measures over the course of the MSSP agreement: first year, pay for reporting; second year and third year, pay for reporting and performance.
  • Realizing shared savings on the first dollar for all ACOs in both Track 1 and Track 2 once the minimum savings rate has been achieved.
  • Providing eligibility to Federally Qualified Health Centers and Rural Health Clinics to form and participate in ACOs.
  • Providing for establishment of the MSPP by January 1, 2012, with the first round of applications due in early-2012, and the first ACO agreements commencing on April 1, 2012 and July 1, 2012.
  • Removing meaningful use of EHR as a requirement for participation.

If you are interested in learning more about ACOs, the Blalock Walters Health Care Team is ready to assist.  Please contact our office for additional information, and stay tuned for our next installment of the Blalock Walters ACO Final Regulations Primer.