CMS proposes ACO rules
June 10, 2011The Centers for Medicare & Medicaid Services (CMS) recently proposed rules for a new health care delivery model that would incentivize groups of individual practitioners and facilities to join together to reduce the overall cost of patient care.
The model, known as “Accountable Care Organizations (ACOs),” were one of the most intriguing developments from last year’s Affordable Care Act (ACA).
The Medicare Shared Savings Program would allow ACOs that meet certain quality standards to share in whatever cost-savings they make for the Medicare program and are widely expected to be expanded or utilized in the private sector.
The AOA has met with key policymakers about the role of optometry in ACOs and provided guidance to the CMS about how ACOs should be formed without discriminating against optometrists.
The AOA will provide additional feedback on the details of the proposed rule.
Under the ACO program, Medicare would continue to pay individual physicians, providers and suppliers for specific items and services under its fee-for-service reimbursement system.
ACOs that beat targets for cost-savings could share in those savings, and, eventually if not initially, ACOs would be liable for higher than expected costs.
The concept is potentially more broad than other cost-control delivery models because all individuals and entities providing patient care would collectively share the incentive and risk.
The ACA requires ACOs to include certain types of practitioners, but not necessarily optometrists.
As suggested by the AOA, the regulations proposed by the CMS would allow optometrists to participate in ACOs.
The AOA will fight to keep this option available in the final regulations.
One measure of ACOs will be the rate of eye examinations for patients with diabetes.
Because only optometrists and ophthalmologists perform eye examinations, this requirement may incentivize ACOs to either include those practitioners within the ACO or to have a strong referral system to ensure that patients get the recommended care for patients whose health care costs would rise substantially if left untreated.
Although widely popular in theory, establishing an ACO is difficult because a wide range of legal issues must be addressed.
In the proposed regulations, the CMS tried to provide flexibility for different ACOs but predicts only 75 to 150 will actually try to participate in the Shared Savings program.
“Optometrists should be aware that these new entities have been proposed to improve care coordination and cost control. ACOs could significantly impact the way participating optometrists provide care,” said Charles B. Brownlow, O.D., third party consultant to the AOA Clinical and Practice Advancement Group. “However, optometrists should be mindful that this is just a proposal and may be changed significantly before final rules are revealed.”
The AOA expects the CMS to issue final regulations this fall.
The Shared Savings Program begins in 2012.
Optometrists should continue to communicate with local practitioners and facilities about the development of ACOs in their areas, and should continue to explain the role optometrists have in efficient, high-quality care.
