Final Accountable Care Organization Rules Established
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LaMagna an attorney and nursing home administrator who practices healthcare regulatory, elder law/special needs and trusts and estates law. He has experience representing clients and facilities alike and is champion for quality patient care. In addition, he is an adjunct professor at Long Island University, teaching graduate students both health law and long term care administration.
CMS released the final regulations ("final rules"), which implement a new form of healthcare organization, the Accountable Care Organization (ACO).
ACOs were created by the Affordable Care Act (ACA) signed into law March 2010 to reduce the increasing cost of healthcare, which is approaching 20% of the gross domestic product. Along with the ACO rules, CMS unveiled the Shared Savings Program (SSP), a program created by Congress to allow the ACOs to share in the savings and possibly the costs of care to Medicare beneficiaries.
The final regulations were released after the proposed rules generated little interest in the implementation of ACOs because they were seen as cost prohibitive. Applications for the implementation of ACOs are currently being accepted through January 1, 2012, and the first ACOs will begin April of the same year.
ACOs are legally and technologically affiliated entities that care for at least 5,000 assigned Medicare beneficiaries. The purpose of ACOs is to realize savings and quality care through the coordination of services among the various providers, which can include: individual physicians, group practices, hospitals, rural hospitals and community health centers, or any combination of the above. The goal of the ACOs will be to promote: 1) effective, patient-centered care for individuals; 2) preventive care for populations; and 3) cost savings (and profit) for the ACOs and Medicare in general. It is apparent that this new healthcare model will address not only the medical needs of its participants, but also the social, nutritional and community needs as well. The cost sharing for the ACOs is determined by not-yet established benchmarks for 33 quality measures (QMs) broken down into four domains:
- Care Coordination/Patient Safety (6 measures)
- Preventive Health (8 measures)
- At-Risk Populations (12 measures)
- Patient/Caregiver Experience (7 measures).
The QMs include measures such as timeliness of physician appointments, effective communication, tobacco use, diabetes control, usage of certain cancer screenings as well as other patient-centered measures. In addition, the use of patient ratings and surveys will determine whether a provider will be reimbursed up to 60% of the savings realized by the organization. This new form of healthcare organization will utilize technology to loosely associate the providers, promote good medical care and accountability to individual patients and populations and save Medicare and eventually Medicaid, private insurance companies and the general healthcare system from skyrocketing costs.
This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, trusts and estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@tllawoffices.com or call him at 914-819-0663 for more information.