CMS “bends” the rules… :: Reliant Rehab

CMS “bends” the rules…

The CMS, in an effort to encourage and strengthen ACOs, gave more flexibility to existing rules.  The CMS believes these rule improvements will “strengthen our ability to reward better care and lay the groundwork for more providers to become successful ACOs.” 

The changes are a result of provider feedback in response to the December of 2014 proposed rule.  275 comments were received from concerned stakeholders and by appropriately responding to these comments, the CMS believes they will maintain 90% of the Medicare Shared Savings ACOs participation.

“The Medicare Shared Savings Program will offer a new track to take on more financial risk of patient care, and it will allow Medicare ACOs to avoid penalties beyond the initial three-year term. The CMS will also issue future guidance on benchmarking and rebasing issues.”

These changes will

  1. Streamline data between the CMS and ACOs
  2. Create a waiver of the three-day skilled nursing facility rule for beneficiaries prospectively assigned to ACOs under Track 3
  3. Bring higher rates of shared savings for those who assume more risk

The increased flexibility and accessibility to ACOs will drive care and reimbursement away from traditional fee for service care. 

HHS Secretary Sylvia Mathews Burwell set a goal in January to tie 30% of all traditional Medicare payments to alternative payment models such as ACOs and bundled payments by the end of 2016 with that goal increasing to 50% by the end of 2018. Adjusting ACO rules to be more accommodating to providers was necessary to see these goals met.

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