ACO Risk-Sharing Under Medicare Shared Savings Finalized

The ruling finalizes risk-sharing for participating providers in accountable care organizations.

Today CMS released the final ruling that addresses payment provisions for accountable care organizations (ACOs) that are a part of the Medicare Shared Savings Program. In addition to traditional fee-for-service payments, participating providers who are part of these integrated delivery systems, and who meet prespecified quality and savings requirements, may be eligible to receive a shared savings payment.

In a statement, acting administrator Andy Slavitt said, "Accountable Care Organizations have shown early but exciting progress in improving quality of care, while providing more patient-centered care at a lower cost. The ACO rules today strengthen our ability to reward better care and lay the groundwork for more providers to become successful ACOs.”

Some of the provisions in the new rule include:

  • Creates a new Track 3, which includes higher rates of shared savings, the prospective assignment of beneficiaries, and the opportunity to use new care coordination tools;
  • Streamlines the data sharing between CMS and ACOs, helping ACOs more easily access data on their patients in a secure way for quality improvement and care coordination that can drive critical improvements in beneficiaries’ care;
  • Establishes a waiver of the 3-day stay Skilled Nursing Facility rule for beneficiaries that are prospectively assigned to ACOs under Track 3; and
  • Refines the policies for resetting ACO benchmarks to help ensure that the program continues to provide strong incentives for ACOs to improve patient care and generate cost savings, and announces CMS’ intent to propose further improvements to the benchmarking methodology later this year.

According to CMS, over 400 ACOs are participating in the Medicare Shared Savings Program, serving over 7 million beneficiaries. Additionally, ACOs improved performance in 30 of 33 quality measures, based on the evaluation of the first 2 years of the program.