CMS’ Final ACO Rule Alters Some Proposed Health IT Provisions

June 8, 2015 in News

On Thursday, CMS issued a final rule for its Medicare Shared Savings Program that includes some changes to health IT provisions outlined in a proposed rule, Health Data Management reports (Slabodkin, Health Data Management, 6/8).

The health IT provisions are part of changes to MSSP that are designed to lower the initial risk of creating an accountable care organization and increase participation in the program.

Background

In December 2014, CMS released a proposed rule that would have allowed CMS to waive certain telemedicine rules, such as requirements that patients be located in rural areas, if deemed appropriate.

In addition, the proposal would have required ACOs to describe how they plan to “encourage and promote” the use of health IT tools to improve care coordination (iHealthBeat, 12/2/14).

Currently, more than 400 ACOs are participating in MSSP, which including more than seven million beneficiaries.

Final Rule Details

In the final rule, CMS made several changes in response to public comments. Among other things, the final rule will:

  • Create a new ACO track based on some of the successful parts of the Pioneer ACO Model, including the opportunity to use new care coordination tools; and
  • Streamline data sharing between CMS and ACOs, allowing participants to easily, and securely access patient data (Health Data Management, 6/8).

The final rule also calls on ACOs to describe in their applications their plans for promoting the use of health IT to improve care coordination. The final rule notes that such tools could include:

  • Electronic health records;
  • Data aggregation and analytics tools;
  • Telehealth services, including remote patient monitoring; and
  • Electronic health information exchange.

However, the rule does not require ACOs to use a certain tool. The rule states, “We are not finalizing additional specific requirements because we agree with commenters that ACOs should have the flexibility to define their care coordination process and use of enabling technologies. We believe this flexibility can encourage innovative methods of engaging both beneficiaries and providers in the coordination of a patient’s care.”

In addition, the final rule does not include the proposed telemedicine waivers for ACOs in Track 1 of the program. CMS said it plans to offer such waivers “starting as early as 2017,” with specific reimbursements based on the agency’s efforts implementing telemedicine-based waivers in the Next Generation ACO Model. In the meantime, CMS said it will consider telemedicine waivers from ACOs in two-sided risk models and those in Track 3 of the program (Bowman, FierceHealthIT, 6/5).

Reaction

Janis Orlowski, chief health care officer at the American Association of Medical Colleges, noted that CMS dropped some proposed changes to MSSP that had alarmed providers and missed opportunities to solidify the program as a driver of value-based payment change. She said, “[W]e hoped to see more tools to support ACOs — (tools that might have made) significant investments in care managers, data systems and quality improvement endeavors.”

Orlowski also expressed disappointment that CMS’ proposed telemedicine waiver was not included in the final rule.

National Association of ACOs President and CEO Clif Gaus also urged CMS to adopt the proposed telemedicine rules (Cheney, HealthLeaders Media, 6/8).

Meanwhile, the American Medical Association praised the rule’s flexibility, saying, “AMA believes the ACO program will be most successful if physicians in each specialty can design and be paid in ways that give them the flexibility to deliver the best care for their patients and allow them to take accountability for the aspects of quality and spending they can manage.” It added, “We encourage CMS to accelerate efforts to accept and approve physician-designed alternative delivery and payment models in addition to its efforts to expand the ACO program” (Health Data Management, 6/8).

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