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The final rule for the Medicare Shared Savings Program is out, aiming to help craft the next generation of Medicare ACOs.
CMS' MSSP final rule is aimed at enhancing primary care services and offering more flexibility in order to increase participation. The agency wants to improve the program in a number of areas, including through a new ACO track based on some of the successful features of the Pioneer ACO Model; streamlining data sharing between CMS and ACOs to help ACOs more easily access data secure patient data; refining policies for resetting ACO benchmarks enable incentives for improving patient care and generating cost savings.
“Accountable Care Organizations have shown early but exciting progress in improving quality, while providing more patient-centered care at a lower cost,” said CMS Acting Administrator Andy Slavitt, in a news release. “The rules strengthen our ability to reward better care and lay the groundwork for more providers to become successful ACOs.”
The final rule also tells ACOs to outline in their application how they plan to implement technologies, which could include electronic health records, data aggregation and analytics tools, and electronic health information exchange.
On accelerating HIE, the regulation covers a few areas, including access for community partners and long-term care.
The agency is clarifying that care coordination includes “coordination with community-based organizations that provide services that address social determinants of health. We understand that ACOs will differ in their ability to adopt the appropriate health information exchange technologies, but we continued to underscore the importance of robust health information exchange tools in effective care coordination.”
ACOs having “a process and plan in place to coordinate a beneficiary's care by electronically sharing health information improves care, and that this helps all clinicians involved in the care of a patient to securely access the necessary health information in a timely manner. It also can also be used to engage beneficiaries in their own care,” regulators wrote.
To meet that vision, the agency added a number of requirements for ACOs to commit to HIE. ACOs will have to describe in applications to “how it will encourage and promote the use of enabling technologies for improving care coordination for beneficiaries,” including telehealth services, health information exchange services, “or other electronic tools to engage patients in their care.” ACOs will also have to define major milestones in implementing those kinds of elements, such as the number of providers expected to be connected to health information exchange services by year and “alert notifications on emergency department and hospital visits.”
The American Medical Association endorsed the final rule, noting that the flexibility will help doctors.
"AMA believes the ACO program will be most successful if physicians in each specialty can design and be paid in ways that give them the flexibility to deliver the best care for their patients and allow them to take accountability for the aspects of quality and spending they can manage," the AMA said in a statement. "We encourage CMS to accelerate efforts to accept and approve physician-designed alternative delivery and payment models in addition to its efforts to expand the ACO program."
ACOs are a part of the Department of Health and Human Services' broader plan to promote better care, more cautious spending, and improved health. The Obama Administration earlier this year announced the goal of tying 30 percent of Medicare payments to quality and value through alternative payment models, such as ACOs, by 2016 and 50 percent of payments by 2018. More than 400 ACOs are participating in the MSSP, serving over 7 million beneficiaries. Early reports showed ACOs improved performance in 30 of 33 quality measures.