CMS Proposes New Rule to Guide ACO Participation
August 28th, 2018
The Centers for Medicare and Medicaid Services (CMS) recently proposed a change to the Medicare Shared Savings Program. The goal is to move accountable care organizations (ACOs) toward a system in which they share in savings they generate but also are responsible for repaying shared losses.
CMS says that its proposal would, among other things, “increase savings for the Trust Funds and mitigate losses, reduce gaming opportunity and increase program integrity, and promote regulatory flexibility and free-market principles.”
According to CMS, most of the 561 ACOs participating in the Shared Savings Program use a one-sided, shared savings-only model. The agency says that under that model, “ACOs receive a share of any savings under their benchmark but are not required to pay back a share of spending over the benchmark.” These ACOs would be asked to sign new contracts reflecting the proposed changes by July 1, 2019.
In a press release, Health and Human Services Secretary Alex Azar said, “One piece of our vision for value-based transformation is pioneering bold new payment models. Having more accountable care organizations take on real risk, while offering them the flexibility they need to generate savings, is an important step forward in how Medicare pays for value.”
Exploring the CMS QAPI Worksheet and Standards
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