The Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would update the methodology used to measure the performance of accountable care organizations (ACOs) participating in the Medicare Shared Savings Program.
The rule is designed to improve long-term incentives for ACOs. The intent is to increase the number of ACOs and to make “ACOs and the coordinated care they provide to patients more of a standard in all parts of the country,” according to CMS.
The proposal seeks to modify the process for resetting the benchmarks used to evaluate ACO performance for organizations that want to renew their participation contracts for a second or subsequent agreement period.
The new methodology would use regional spending growth trends instead of national trends when establishing and updating an ACO’s rebased benchmark. It also would adjust an ACO’s rebased benchmark when the organization enters a second or subsequent agreement period by a percentage of the difference between fee-for-service spending in the ACO’s regional service area and the ACO’s historical spending. The percentage would increase over time, providing more incentive for continued participation and improvement.
Implementation would be phased in, giving ACOs time to prepare for the benchmarks that incorporate regional expenditures.
Separately, CMS proposed new rules required by the Medicare Access and CHIP Reauthorization Act that will increase access to analyses and other data among providers and employers.
The rules will allow approved organizations (i.e., “qualified entities”) to confidentially share or sell analyses of Medicare and private insurer claims data to providers, employers and other groups who can use the data to make more informed health care decisions, CMS said. So far, 13 organizations have applied for and received approval to be a qualified entity.
The rules include strict privacy and security requirements for all entities receiving Medicare analyses or data, as well as new annual reporting requirements.
The proposed rules are available at the Federal Register website. Comments are being accepted for 60 days.