CMS issues final rule for shared savings program

The Centers for Medicare & Medicaid Services (CMS) has released a final rule updating the Medicare Shared Savings Program (MSSP) that enhances the focus on primary care services and provides additional flexibility in the program to encourage increased participation. 

The agency said the rule includes modifications made after considering comments received when the note of proposed rulemaking was released in December 2014. For example, the rule refines the policies for resetting accountable care benchmarks to help ensure that the program continues to provide strong incentives for ACOs to improve patient care and generate cost savings, and announces CMS’ intent to propose further improvements to the benchmarking methodology later this year.

The rule also creates a new Track 3, based on some of the successful features of the Pioneer ACO Model, which includes higher rates of shared savings, the prospective assignment of beneficiaries and the opportunity to use new care coordination tools. The rule streamlines data sharing between CMS and ACOs so ACOs can access patient data more easily for quality improvement and care coordination that can drive critical improvements in beneficiaries’ care and establishes a waiver of the 3-day stay skilled nursing facility (SNF) rule for beneficiaries that are prospectively assigned to ACOs under Track 3.

More than 400 ACOs are participating in the Medicare Shared Savings Program, serving over 7 million beneficiaries. Data released last November indicated that MSSP ACOs starting in the first two years of the program improved quality of care for beneficiaries, as ACOs improved performance in 30 of 33 quality measures. The Pioneer ACO program has saved the Medicare program $384 million in total, or $300 per Medicare beneficiary per year. Participating providers saved Medicare $279.7 million in 2012 and $104.5 million in 2013, according to an independent evaluation report released by CMS in May.