The federal government continued its push toward accountable care as it launched two initiatives derived from the Affordable Care Act (ACA) on Thursday–the Medicare Shared Savings Final Rule and the Advance Payment Model. The Centers for Medicare and Medicaid Services (CMS) said the Final Rule incorporates many changes recommended by hospitals and physician groups that were critical of the draft Rule, when it was first published in March. More than 1,200 comments were submitted, according to the CMS. One notable change was a reduction in quality measures that would be monitored by CMS, from 65 in the original proposal to 33 in the Final Rule.

The Shared Savings Program Final Rule can be seen at: http://www.ofr.gov/OFRUpload/OFRData/2011-27461_PI.pdf.

In June, the NCMS Accountable Care Task Force addressed the proposed Rule in a letter to CMS Administrator Donald Berwick, MD. NCMS President John R. Mangum, MD, stated in the letter, “While the NCMS strongly supports the goals of the Shared Savings Program to improve health and quality and to control costs, we are convinced that the proposed ACO rules are seriously flawed and that, as currently structured, the Shared Savings Program is likely to fail.”

The letter followed an intensive eight-week review of the Rule by the NCMS Task Force, chaired by Steve Wegner, MD, JD. Read the letter here.   

CMS says the Advance Payment Model will provide additional support to physician-owned and rural providers participating in the Medicare Shared Savings Program. Included are start-up resources to build needed infrastructure, such as new staff or information technology systems. Details about the Model are available at http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/advance-payment.

The NCMS will be reviewing the Medicare Shared Savings Final Rule and Advance Payment Model and will provide additional updates in future Bulletins and in the Toward Accountable Care section of the NCMS website.