In late March, CMS released a proposed rule regarding the Accountable Care Organization (ACO) program. Mandated by H.R. 3590, the Patient Protection and Accountable Care Act of 2010 (PPACA), the ACO program is widely viewed as one of the most important components of current efforts to transform care delivery and reform the payment system. Before CMS finalizes the ACO rule, it is soliciting comments from the medical community on the appropriateness and implications of its proposals for the program, which are described in the ACO Proposed Rule.
Earlier this year, ASN formed an ACO Task Force charged with scrutinizing the proposed rule and providing comments to CMS. Given the potential influence this proposed rule could ultimately have on reimbursement and care delivery in all areas of medicine—including nephrology—the ASN Council and Public Policy Board believed it was imperative that the society provide feedback to CMS about it. This task force will ensure that CMS takes into account the perspective of nephrologists and their patients as it develops the ACO program (Table 1).
“Given the growing number of people with chronic kidney disease, and the complexity and costliness of kidney—and particularly dialysis—care, greater care coordination in the context of an ACO could potentially lead to better outcomes, improve the transition of care for patients with late-stage CKD to dialysis, and generate savings,” said Thomas Hostetter, MD, chair of the ASN Public Policy Board. “It’s hugely important that ASN and its ACO Task Force work with CMS to make sure the unique needs of patients with kidney disease are front-and-center in CMS’ mind as the agency develops the ACO Program.”
Congress mandated that the ACO program begin no later than January 1, 2012. However, CMS and the Secretary of Health and Human Services have significant discretion in translating the legislation into regulation—determining the specifics of who can participate in ACOs, what an ACO model can look like, and the quality standards ACOs will have to meet. The release of the proposed rule is the first step in that process.
The law does specify, among other things, that an ACO will care for a clearly defined population of Medicare beneficiaries, who will be assigned to it based on the beneficiaries’ patterns of primary care use. If an ACO meets certain quality standards (which CMS suggests in the proposed rule) and reduces the cost of that care to a level below what would otherwise have been expected, it will get to keep some of the savings it achieves.
The ASN ACO Task Force and the Public Policy Board will provide more information about the contents of the proposed rule as well as ASN’s comments to CMS in the coming weeks. CMS is accepting public comments until Monday, June 6, 2011. You can access a copy of the proposed rule on ASN’s patient care policy webpage http://www.asn-online.org/g/?o=patientcare.
