New accountable care organization rules proposed by Department of Health and Human Services

May 1, 2011

On March 31, the US Department of Health and Human Services released proposed new rules to help physicians and other healthcare providers better coordinate care for Medicare patients through accountable care organizations.

On March 31, the US Department of Health and Human Services (HHS) released proposed new rules to help physicians and other healthcare providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). ACOs, groups of providers of services and suppliers that work together to coordinate care for Medicare fee-for-service beneficiaries, create incentives for healthcare providers to work together to treat an individual patient across care settings.

Under the Medicare Shared Savings Program, ACOs that lower growth in healthcare costs while meeting performance standards for quality of care will be rewarded. The performance quality standards cover 5 areas: patient/caregiver care experiences, care coordination, patient safety, preventive health, and at-risk population/frail elderly health.

The Medicare Shared Savings Program arose from the Affordable Care Act, which required the Centers for Medicare & Medicaid Services (CMS) to establish a shared saving program to facilitate coordination and cooperation among providers to improve the quality of care for Medicare fee-for-service beneficiaries and reduce unnecessary costs. Eligible providers, hospitals, and suppliers may participate in the shared savings program by creating or joining an ACO.

HHS will accept comments from the public on the proposed rule through June 6, 2011. Before finalizing the rule, CMS will read all public comments and will amend its proposals based on those comments. The new program will be established on January 1, 2012.

Affordable Care Act to improve quality of care for people with Medicare [press release]. Washington, DC: US Department of Health and Human Services Press Office; March 31, 2011. http://www.hhs.gov/news/press/2011pres/03/20110331a.html. Accessed April 8, 2011.

Shared Savings Program, Overview. Centers for Medicare & Medicaid Services Web site. http://www.cms.gov/sharedsavingsprogram/. Accessed April 8, 2011.