The final Accountable Care Organization (“ACO”) rules to be published next months continue to provide two alternative ACO “tracks” for participation, but have made one of the options more user friendly. The Medicare Shared Savings Program (“MSSP”) is a new conceptual provision of the Obama Administration’s Accountable Care Act (“ACA”) that permits physicians and hospitals who are serving Medicare patients on a fee for service basis to band together to achieve greater efficiency and accountability through the opportunity to benefit from any cost savings to the program.
To qualify for the MSSP program ACOs must agree to take at least 5000 patients for a period of three years. They must also select one of two tracks for providing care. The first track originally provided for a sharing of savings only for the first two years with a risk sharing for losses in the third year. The purpose of this track was to provide a level of protection for fledgling ACOs to get acclimated to the program before going at risk. The final rules extend this option for all there years of the initial contract.
The second track if for those ACOs who already have experience with clinically integrated systems who are “spade ready” and prepared to undertake both benefits and risk for the entire program. Second track participants have the opportunity to share in a greater amount of the savings (60%) than track one ACOs (50%). The amounts of the savings bonuses to be paid are to some extent performance driven by 4 categories of quality measurements that the ACOs must report to the government.
For a comparison of the draft rule and final rule see below.