The recently published Centers for Medicare & Medicaid Services (CMS) rules on accountable-care organizations (ACOs) are an improvement over the draft rules from this spring, but whether they spur wider formation of the new care model remains to be seen, a leading hospitalist says.
"They did some smart things," says Ron Greeno, MD, MHM, chief medical officer of Brentwood, Tenn.-based Cogent HMG and chair of SHM's Public Policy Committee. "I don't know yet that I have a great feel for how many people are going to apply—certainly more than before."
Released in March, the draft rules prompted more than 1,000 formal comments, spurring changes in several areas, including a significant reduction in the number of quality measures that CMS would monitor (33 from 65), and the elimination of assigning patients to ACOs retrospectively.
The revisions have been made to the Pioneer ACO Model, which offers higher payments to providers and organizations that already have experience with shared savings contracts, and a related program, the Medicare Shared Savings Program, which requires no previous experience.
Overall, the changes "increase incentives and eliminate downside risk," Dr. Greeno says, adding that he would like even more incentives to encourage more providers and organizations to participate. A recent white paper from healthcare research group Leavitt Partners of Salt Lake City identified 165 ACOs nationwide. Dr. Greeno believes that with more opportunity for providers and health systems to share in potential savings, that number can grow quickly.
In a comment letter posted to its website, SHM suggested "that limiting the incentive will also limit the results. ACOs that continually innovate to achieve progressive savings should have ongoing incentives to do so.”
"It's like [CMS] wants this to work, but they're almost scared people will make money doing this," he adds. "If you think this is important, make it worthwhile ... let organizations find the level of risk they're comfortable taking. And reward them accordingly if they're successful."