CMS Seeks Comments On New Standards For ACOs; AMA and Other Health Organizations Respond

The Centers for Medicare & Medicaid Services (CMS) has officially requested comments from the physician community regarding policies and standards for accountable care organizations (ACOs) participating in the Medicare program under the Shared Savings Program or in connection with the Center for Medicare and Medicaid Innovation (CMMI).

CMS’s request focuses on three areas of interest: participation of solo and small practice providers in ACOs; attribution of beneficiaries to ACOs; and the assessment of performance, quality and efficiencies of ACOs. Below is a summary of the information CMS is seeking, but the full request and directions for submitting comments can be found here: http://tinyurl.com/2a29moo. Please note that the deadline for comments to be submitted to CMS is 5:00pm on December 3rd, 2010.

Solo and small practice providers. How can solo and small practice providers be ensured equal opportunity to participate in Shared Savings Plans created by the Medicare program? How can these providers be given sufficient access to capital needed to fund their efforts? Should CMS consider other payment models besides those currently available to Medicare providers?

Attribution of beneficiaries. CMS is seeking a seamless attribution process of beneficiaries to ACOs. What is the best process and timing for this: before the start of a performance period, in order to target care coordination strategies, or at the end of a performance period to ensure accountability?

ACO Assessment. How can CMS evaluate ACOs based on the patient-centered criteria required by the Affordable Care Act? What quality measures should the secretary of the U.S. Department of Health and Human Services use to determine performance in the Shared Savings Program?

In a letter from the American Hospital Association (AHA) to CMS dated November 17, 2010, the AHA outlined principles that it would like to see guide the agency’s approach to implementing ACOs. It said the goal of ACOs must be “delivery reform that improves quality, efficiency and the patient experience through accountable care,” and suggested that the need for Medicare program savings should not hinder this type of delivery reform. The AHA’s position is that the ACO program should be “treated as a pilot initially so that mid-course corrections can be implemented to reflect what is learned.” Importantly, the association encouraged CMS to “explore opportunities to extend similar arrangements to rural providers who are interested in adopting delivery reforms.” The full text of the AHA’s letter to CMS can be seen here: http://tinyurl.com/299xnqo.

The Premier healthcare alliance, based in Charlotte, NC, is also among the major healthcare organizations who have already submitted a letter with recommendations to CMS regarding ACOs. Premier’s letter asks that the Medicare ACO program be “flexible enough to allow innovation, but rigid enough so that the initial ACOs in the program inspire confidence in the concept.” Premier also encouraged CMS to recognize physician assistants, nurse practitioners and certified nurse specialists as clinical providers that are equally eligible for Medicare Shared Savings bonuses. Like the AHA, Premier believes that such non-physician practitioners “will be central in developing a strong primary care base, particularly in rural and shortage areas.” Premier’s letter can be found here in its entirety: http://tinyurl.com/2vd26of.

Finally, the American Medical Association (AMA) defined a robust set of guidelines for ACOs at the organization’s semi-annual policy-making meeting. These principles, which happen to coincide with CMS’s request for comments and recommendations, emphasize that ACOs must be physician-led to guarantee quality patient care, be patient-centered in their focus, ensure that physician and patient participation stays voluntary and enable independent physicians to participate. The latter is of particular concern to the AMA, as significant barriers must be addressed to guarantee that physicians in all practice sizes can be successful in the new ACO models. For solo and small practice physicians, these barriers include a lack of resources, existing antitrust rules and conflicting federal policies. The AMA urges CMS to keep quality performance standards consistent with AMA policy and to allow ACOs to use different payment models. A complete list of all 13 principles of the AMA’s new policy regarding accountable care organizations can be found here: http://tinyurl.com/2aamuyz.

Please continue to visit www.thehlp.com for further ACO-related developments and, in particular, view the resources at our ACO page.

For more information, please contact Carey F. Kalmowitz, Esq., Adrienne Dresevic, Esq., Abby Pendleton, Esq. or Esq. at (248) 996-8510 or (212) 734-0128.