On Thursday, CMS released its final rule on Medicare accountable care organizations and removed a requirement that at least 50% of ACO physicians achieve meaningful use of electronic health records, Health Data Management reports.
Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments.
The final rule will be published in the Federal Register on Nov. 2 (Goedert , Health Data Management, 10/20).
Under the federal health reform law, the ACO program offers incentives for groups of medical professionals who provide every aspect of patients' care. If ACOs are able to reduce costs, CMS will reward the providers with a portion of the savings.
The agency expects the program to help Medicare reduce costs by as much as $940 million over four years.
CMS issued a proposed rule on ACOs earlier this year, but many medical groups said they might not participate in the program because some provisions of the rule were too restrictive (Radnofsky, Wall Street Journal, 10/21).
For example, the proposed rule included a provision that half of an ACO's primary care physicians meet meaningful use rules by the beginning of the second year of an ACO's agreement with CMS (iHealthBeat, 6/9).
Health IT Changes Under Final Rule
The final rule does not include the requirement that 50% of participating physicians achieve meaningful use.
The rule does retain EHR use as a quality measure and weights it higher than any other measure for quality reporting purposes (Merrill, Healthcare IT News, 10/20).
In addition, the rule states that ACO participants can use survey, claims and administrative information to report quality measures instead of EHRs. Participants also can use a Web-based group practice reporting option for submission of quality measures (Gamble, Becker's Hospital Review, 10/20).
The final rule also reduced from 65 to 33 the number of quality measures CMS will use to gauge performance (Evans, Modern Healthcare, 10/20).
Other Key Changes
HHS also launched a complementary program -- the Advance Payment model -- that will experiment with whether prepaying a portion of potential future savings will encourage ACO participation and whether advance payments will help providers improve care and reduce costs more quickly (Goedert , Health Data Management, 10/20).
The final rule also:
- Eliminates the practice of barring ACOs with net losses from continued participation in the program, if the ACOs meet all other requirements (Becker's Hospital Review, 10/20);
- Assigns patients to ACOs up front rather than retrospectively; and
- Allows ACOs to share on all savings earned after qualifying by earning a minimum savings rate, rather than allowing them to share in all savings after reducing costs by 2% (Modern Healthcare, 10/20).
Members of the Premier healthcare alliance said they are pleased that CMS waived its initial requirement that at least 50% of an ACO's physicians achieve meaningful use.
In a statement, Premier said that existing penalties for health care providers who do not meet meaningful use are incentive enough to encourage health IT adoption and that the proposed rule would have "limit[ed] the inclusion of innovative physicians who are seeking to improve their patients' care" (Goedert , Health Data Management, 10/20).
Bill Bernstein -- chair of the healthcare division at law firm Manatt, Phelps & Phillips -- said he was surprised that CMS lifted the 50% standard for physicians to demonstrate meaningful use.
Tracey Moorhead -- president and CEO of the Care Continuum Alliance -- said, "We're encouraged CMS chose to streamline its quality reporting requirements ... to focus on priority areas and those of high prevalence and cost" (Sullivan, Government Health IT, 10/20).