HHS Proposes Accountable Care Organization RulesHHS Proposes Accountable Care Organization Rules

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The release of proposed rules that will help guide doctors, hospitals, and other healthcare providers coordinate care for Medicare patients through accountable care organizations (ACOs) reveals that the Department of Health and Human Services (HHS) is seeking to more closely align the Medicare Shared Savings Program with the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs as a way for ACOs to simplify reporting requirements related to performance measures.

HHS published the 429-page document Thursday, saying ACOs will create incentives for healthcare providers to work together to treat an individual patient across care settings -- including doctor's offices, hospitals, and long-term care facilities. The document also outlined the ways in which technology will support healthcare providers' ability to capture data as they meet performance measures under the ACO model of care.

"The collection of information should minimize the burden on providers to the extent possible. As part of that effort, we have begun and will continuously seek to align Shared Savings Program measures with the methods and measures included in the Medicare and Medicaid EHR Incentive Programs to enable the collection and reporting of performance information to be a seamless part of care delivery and the meaningful use of certified EHR technology," the document said.

One of the proposals that demonstrate how this can be achieved was outlined this way: "We propose to require in the Shared Savings Program measures also included in the EHR Incentive Program and metrics related to successful participation in the Medicare and Medicaid EHR Incentive Programs for eligible professionals and hospitals and the eRx Incentive Program."

The Medicare Shared Savings Program will reward ACOs that lower healthcare costs while meeting performance standards on quality of care to raise patient priorities. Patient and provider participation in an ACO is voluntary.

An ACO is a recognized legal entity under state law and comprised of a group of ACO participants (providers of services and suppliers) that have established a mechanism for shared governance and work to coordinate care for Medicare fee-for-service beneficiaries. ACOs enter into a three-year agreement with the Centers for Medicare and Medicaid Services (CMS) to be accountable for the quality, cost, and overall care of traditional fee-for-service Medicare beneficiaries who may be assigned to it.

With regard to other areas of technology that will play a part in supporting ACOs' ability to raise their performance objectives, the document noted that ACOs will be required to "define processes to... coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies."

"For too long, it has been too difficult for healthcare providers to work together to coordinate and improve the care their patients receive," HHS secretary Kathleen Sebelius said in a statement. "That has real consequences: patients have gaps in their care, receive duplicative care, or are at increased risk of suffering from medical mistakes. Accountable care organizations will improve coordination and communication among doctors and hospitals, improve the quality of the care their patients receive, and help lower costs."

HHS also announced it will hold a series of open-door forums and listening sessions during the comment period to help the public understand what the Centers for Medicare & Medicaid Services (CMS), the agency administering the ACO program, is proposing to do and to ensure that the public understands how to participate in the formal comment process.

By focusing on the needs of patients and linking payment rewards to outcomes, the ACO delivery model, as part of the Affordable Care Act, will help improve the health of individuals and communities while saving as much as $960 million over three years for the Medicare program, HHS said in a statement.

For example, by improving access to primary care so that patients can avoid a trip to the emergency room, the ACO can share in those savings with Medicare.

ACOs that do not meet quality standards cannot share in program savings, and over time, those who do not generate savings can be held accountable. The new program will be established on January 1, 2012. Before the rule is finalized, CMS will review all comments from the public and may make changes to its proposals based on those comments.