Accountable Care Organizations:Perspectives on the Proposed Rule

Susan DeVore

President and CEO

May 13, 2011

Working toward population health

Process Improvement(Evidence-Based

Care)

Systematic improvement (Inpatient/outpatient

value)

Population total value

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42 States redesigning care

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What we like

• Timely data from CMS: (A,B, and D data as often as monthly)

• CMS and ACOs educating beneficiaries• Multiple payment models• Consensus-based measures• Clinically integrated for anti-trust purposes• Safe harbor under anti-kickback and CMP• Anti-trust safety zones and 90 day expedited

advisory opinion process

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Priority payment issues

• Model with no downside risk: In both of the proposed models, hospitals must accept two-sided risk. Only some of our members are prepared to take that risk. We also believe that CMS should reduce the 25% withhold in the two-sided model and eliminate it if there is an option without risk.

• Higher shared savings: CMS should reconsider its savings split to share back 70-80%of the total in preliminary years of the program, instead of 52.5/65%, or adjust the confidence interval requirement.

• Capitation: While CMS does propose multiple payment models, it does not include a partial capitation model. We encourage this be offered either through the program or the Center for Medicare and Medicaid Innovation.

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Priority issues with standards, incentives and risk

• Quality measures: Reduce the proposed 65 measures and 50% primary care meaningful use requirements.

• Value-added services: Expand beneficiary communications and services including: pay for travel, technologies, seminars, co-pay waivers, etc.

• Risk adjustment: Allow the ACO risk score to grow rather than holding it constant to the baseline period.

• Legal waivers: Support waiving Stark, anti-kickback and CMP laws for distributions of shared savings, but ACOs should be allowed broader exceptions for specialists not part of the ACO.

• Calculations: Exclude add-ons such as IME and DSH as well as wage adjust the benchmarks and expenditures as these factors cannot be affected and are unrelated to care transformation.

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