Highlights from CMS Telephone Conference on Accountable Care Organizations

On April 7, 2011 CMS held a telephone conference for hospitals to answer questions on the recently released Accountable Care Organizations proposed rule and to provide further instruction on the submission of comments to CMS for consideration.

The CMS representatives stated that more information regarding the Centers for Medicare and Medicaid Innovation Center would also be provided soon. This statement arose in light of questions regarding possibilities for ACOs that are not quite ready for the Shared Savings Program. The representatives did reiterate that, pursuant to the statute, ACOs will not be able to participate in more than one shared savings program. The representatives further stated that the required organizational structure for ACOs wishing to participate in other programs might not necessarily be the same as for the Medicare Shared Savings Program.

CMS representatives also discussed the fact that primary care services provided by rural health clinics or federally qualified health clinics would not be considered in the patient attribution process because CMS does not collect sufficient data in claims from these organizations to determine whether the services are “primary care”.

The representatives also discussed the fact that information regarding the application process will be available after publication of the final rule and that they anticipate an annual application process, even though there is a three year commitment. They also stated that they contemplate opportunities for renewal after the initial three year term since this is a permanent program rather than a demonstration program.

CMS representatives also discussed that, for antitrust purposes, applicants will be required to submit information regarding the share of services in their Primary Service Area (PSA). When asked how applicants will be able to calculate this information, since it is not publically available, they stated that the data will be made available to ACO applicants in order to assist with this calculation.

CMS representatives also stated that they do not intend to provide formulas or methodologies for distribution of the shared savings from the ACOs to the participants, but that they do expect ACOs to provide this information with their application as well as an explanation as to how the distribution method will help to achieve the triple aim of better care for individuals, better health for the population and cost control.

The representatives encouraged interested parties to submit comments electronically via www.regulations.gov and by entering the file number CMS 1345-P. If you need assistance with ACO formation or submission of comments, please contact a Wachler & Associates, P.C. attorney.