Accountable Care Organizations (ACOs) have been a hot topic in Washington as the administration looks for new payment models for Medicare physicians.
Accountable Care Organizations (ACOs) have been a hot topic in Washington as the administration looks for new payment models for Medicare physicians. CMS recently proposed regulations for the ACO model. An ACO is a group of providers who work together to coordinate the care of traditional Medicare beneficiaries. The Federal Trade Commission and the Justice Department have proposed a safe harbor against anti-trust lawsuits for ACOs that account for 30% of the Medicare fee-for-service business in the local area. Larger ACOs with at least half of the fee-for-service business in a local area must undergo an expedited anti-trust review.
CMS has proposed that an ACO enter into a three-year agreement as a condition of participation and have a formal structure to receive and distribute shared savings to providers. The ACO must also have at least 5,000 Medicare beneficiaries and include primary care providers. Quality will be measured in patient/ caregiver experience of care, care coordination, patient safety, preventative health and at-risk population/frail elderly health. CMS is hoping to serve up to 5 million beneficiaries through the ACO program and potentially save the Medicare program $960 million over three years.