CMS updates ACO rule, includes third track for savings

A new final rule published by CMS updates the Medicare Shared Savings Program (MSSP) by providing Accountable Care Organizations (ACOs) with a new track for shared saving, more flexibility, and more incentives.

“Accountable Care Organizations have shown early but exciting progress in improving quality of care, while providing more patient-centered care at a lower cost,” Andy Slavitt, CMS acting administrator, said in a statement. “The ACO rules today strengthen our ability to reward better care and lay the groundwork for more providers to become successful ACOs.”

The final rule creates a “Track 3”—care providers in ACOs previously chose one of two existing tracks for shared savings—that consists of more potential savings, more risk, and assigned beneficiaries. The rule also establishes a waiver of the three-day Skilled Nursing Facility rule for beneficiaries assigned to ACOs that choose Track 3.

In addition, the rule allows ACOs following the first track to enter a new three-year period during which they will continue to earn incentives, but cannot be penalized. CMS said additional changes to benchmarking methodology will be announced later this year.

The MSSP was first created by the Affordable Care Act. It is a voluntary program, and organizations make a three-year commitment when they join. As of January 2015, there are 405 ACOs in the United States.

In May, the Department of Health and Human Services (HHS) announced that its Pioneer ACO Model—which covers more than 600,000 Medicare beneficiaries—saved the Medicare program over $384 million in two years. Successful elements of the Pioneer ACO Model were used to create the MSSP’s new Track 3.

“The Affordable Care Act gave us powerful new tools to test better ways to improve patient care and keep communities healthier,” HHS Secretary Sylvia Mathews Burwell said in a statement when the results were published. “The Pioneer ACO Model has demonstrated that patients can get high quality and coordinated care at the right time, and we can generate savings for Medicare and the health care system at large.”

CMS published a Notice of Proposed Rulemaking in December 2014 and took public comments into consideration before releasing this final rule.