Twenty-seven new Accountable Care Organizations (ACOs) in 18 states have entered into voluntary agreements with the Centers for Medicare & Medicaid Services (CMS) under the new Medicare Shared Savings Program (MSSP). Under the MSSP, as previously discussed, these selected ACOs have agreed to take responsibility for improving the health and care experience of individuals in the traditional Medicare fee-for-service population while reducing the rate of growth in health care spending. The 27 ACOs, which include more than 10,000 physicians, 10 hospitals, and 13 smaller physician-driven organizations in both urban and rural areas, will serve an estimated 375,000 Medicare beneficiaries.
MSSP Quality Standards
The selected ACOs must meet strict quality standards to ensure that savings are achieved through improving and providing care that is appropriate, safe, and timely. For 2012, CMS has established 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and the patient and caregiver experience of care. Their models for coordinating care and improving quality must be responsive to the needs of the beneficiaries in the areas they are serving.
How Did MSSP Come About?
Section 3022 of the Patient Protection and Affordable Care Act (P.L. 111-148) added a new section 1899 to the Social Security Act requiring the Secretary of HHS to establish the MSSP. On November 2, 2011, CMS published a Final rule in the Federal Register (76 FR 67802) implementing the MSSP. The Final rule addressed issues relating to eligibility, governance, beneficiary rights, quality measures, performance scoring, and CMS monitoring of the ACO operations. The ACOs were offered the option of starting in the program on either April 1 or July 1, 2012.
At the same time, the CMS Innovation Center announced an Advance Payment ACO Model to test whether providing advance payments from anticipated savings could encourage certain rural and physician-based entities to apply to participate in the program.
Finally, in conjunction with the Final rule, the HHS Office of Inspector General (OIG), the Department of Justice, the Federal Trade Commission, and the Internal Revenue Service issued separate notices addressing a variety of legal issues as they applied to the MSSP. These issuances included an OIG Interim final rule, which provided waivers for the MSSP participants with regard to the federal anti-kickback, physician self-referral, and gainsharing civil monetary penalty laws. Other department notices dealt with antitrust law concerns and the tax implications of the Internal Revenue Code for nonprofit entities seeking to participate in ACOs.
What is the Total ACO Participation to Date?
These 27 new ACOs will bring the total number of organizations participating Medicare shared savings initiatives to 65 as of April 1, 2012, including the 32 Pioneer Model ACOs that were announced in December 2011, and six Physician Group Practice Transition Demonstration organizations that started in January 2011. In all, under these initiatives, more than 1.1 million beneficiaries will receive care from providers participating in Medicare shared savings initiatives. CMS also is reviewing more than 150 applications from ACOs seeking to enter the program in July.
Are Start-Up Resources Available to New ACOs?
CMS has also announced that five of the 27 ACOs are participating in the Advance Payment ACO Model beginning April 1, 2012. This model will provide advance payment of start-up resources to rural and physician-based ACOs participating in the MSSP. These start-up resources will help pay for the necessary care coordination infrastructure necessary to improve patient outcomes and reduce costs, such as new staff or information technology systems. CMS is reviewing more than 50 applications for advance payments that start in July.
Can ACOs Still Apply?
CMS will announce the date for submission of applications to participate in the MSSP beginning in 2013 later this year.