CMS released new information about ACOs this week which will allow patients to choose whether they get all of their care from one ACO or multiple ones.This is an important clarification as it may make it even more difficult to track which part of the provider system gets paid for what.
CMS Issues First Clarification of Accountable Care Organizations
CMS recently offered the first glimpse into what accountable care organizations (ACOs) will look like in the form of a document with preliminary questions and answers about ACOs. Though much still remains to be worked out, CMS is now telling us that ACOs will be required to assume responsibility for a minimum of 5,000 Medicare beneficiaries and will receive financial rewards for improving quality and reducing costs for those beneficiaries.
The biggest new information in the CMS document is that ACOs will not be allowed to restrict the access of Medicare beneficiaries to physicians, hospitals, or any other providers. In other words, ACOs will not be allowed to utilize gate keeper or restricted network strategies. The most likely reason CMS has made this determination is that a scared and angry citizenry is already afraid that healthcare reform will limit their access to providers and benefits, so CMS is going on public record saying that ACOs, a major element in the recently passed healthcare reform bill, will not be able to do so.
CMS to Host June 24 Call on Medicare Accountable Care Organizations
The Centers for Medicare & Medicaid Services will host a conference call June 24 to solicit comments from hospitals and physicians on implementing Medicare accountable care organizations under the health reform law's Shared Savings Program. Among other topics, CMS seeks input on: joint accountability among providers in the formation and use of ACOs; cost and quality measures to assess performance; risk adjustment; attribution of Medicare beneficiaries to ACOs; benchmarks for defining shared savings; coordination with other value-based purchasing initiatives; and Medicare beneficiary protections.
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