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CMS ramps up for ACOs, seeks physician input

The Centers for Medicare & Medicaid Services is requesting stakeholders – particularly physicians – to give their two cents on accountable care organizations.

CMS has released a draft of the request for information. The official request will appear soon in the Federal Register, after which CMS will take comments for 21 days.

Under the Affordable Care Act, CMS is charged with testing innovative payment and care delivery models to reduce cost and improve quality. The agency's solicitation of comments comes as CMS prepares to develop rules for the establishment of the Shared Savings Program and a Center for Medicare and Medicaid Innovation called for under the ACA.

"We have already conducted substantial outreach and had discussions with and received feedback from a wide array of physician groups, as well as groups representing other clinicians, hospitals, employers, consumers and other interested parties, about how ACO programs can best be structured," CMS officials said. Now, CMS is hoping to get physician feedback on how to ensure that solo and small-practice physicians will participate in ACOs.

ACOs are still somewhat in a concept phase, but are intended to be a form of integrated care that involves data-sharing between groups of physicians and hospitals to improve a local population's overall health.

Douglas Henley, MD, executive vice president of the American Academy of Family Physicians, said at this point, "nobody really knows or understands what an ACO is." The AAFP is looking forward to CMS rulemaking on ACOs, expected out within the next two to three months.

One thing Henley does know: if ACOs don't emphasize primary care and prevention, they won't achieve their ultimate goal of better population health at a lower cost.

Henley said he hopes the new ACO regulations won't be so rigid that they stifle innovation at the community level. How each community will approach the formation of an ACO needs to vary, he said, just as communities themselves do.

CMS should "let a thousand flowers bloom and let them learn from each other," Henley said. In its rulemaking, he said, CMS "should avoid a rigid federal approach."

A challenge for ACO development will be getting hospitals and doctors to trust each other more. "Right now they are not necessarily close allies," Henley said, "but we need to get beyond that and come together to achieve common goals." That's going to take some "very good communication and very good planning," he said.

In its request for information, CMS would also like to know what payment models and other mechanisms it could use to help small physicians practices afford to participate in ACOs, and how it should assess the beneficiary and caregiver experience of care as part of our assessment of an ACO's performance.

Other questions CMS would like feedback on include:

  • What aspects of patient-centeredness are particularly important for CMS to consider and how should it evaluate them?

  • In order for an ACO to share in savings under the Medicare Shared Savings Program, it must meet a quality performance standard determined by the Health and Human Services Secretary. What quality measures should the secretary use to determine performance in the Shared Savings Program?