Value-Based Payment, Accountable Care, and the ACO Final Rule: Are We Making Progress? on the Health Affairs Blog

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Following is an excerpt:

To answer the question in my title, I think we are making progress, and the Medicare Shared Savings Program (MSSP) Final Rule is a positive contribution. As I said in my post on April 5 about the MSSP Proposed Rule, the Centers for Medicare and Medicaid Services' implementation of the very specific provisions of Section 3022 of the Affordable Care Act — in conjunction with the Federal Trade Commission, the Department of Justice, the HHS Office of Inspector General, and the Internal Revenue Service — constitutes a thoughtful and comprehensive effort that will (1) create more consistency in the treatment of ACOs by all payers, (2) foster a better understanding of the minimum requirements to qualify as a Medicare ACO, and (3) indicate how enforcement agencies will view ACO activities in both the Medicare and commercial markets.

With the Final Rule, CMS again has made a significant contribution to the national dialogue on accountable care and the important role ACOs can have in helping to achieve the Triple Aim. Moreover, while all stakeholders may not agree with every revision made in the Final Rule, CMS clearly has responded carefully and thoughtfully to the over 1,300 comments received by stakeholders on the Proposed Rule. At the very least, this represents a healthy public-private dialogue on an important topic, which is how rulemaking is supposed to work.

Regardless of one's view of the provisions in the Final Rule, the 622 pages of preamble to the Rule represent a tremendously rich and intelligent discussion of the options that commenters suggested and the pros and cons that CMS considered. It will take several days of reading to get through all of it, but the analysis in the preamble will be instructive to state and commercial market ACO efforts even where different options and provisions are chosen.

Douglas A. Hastings currently serves as Chair of the Board of Directors of Epstein Becker & Green, P.C. He is a Member of the Firm's Health Care and Life Sciences Practice in the Washington, DC office.