Final Rule for Medicare Shared Savings Program Aimed at Providing Flexibility, Encouraging High-Quality Care

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On June 4, 2015, the Centers for Medicare and Medicaid Services (CMS) issued a final rule updating the Medicare Shared Savings Program. The rule is aimed at encouraging the delivery of high-quality care for Medicare beneficiaries, focusing on primary care and providing additional flexibility in the program to increase participation.

The final rule:

  • Creates a new Track 3, based on some of the successful features of the Pioneer Accountable Care Organization (ACO) Model, which includes higher rates of shared savings, the prospective assignment of beneficiaries, and the opportunity to use new care coordination tools
  • Streamlines the data sharing between CMS and ACOs, helping ACOs more easily access data on their patients in a secure way for quality improvement and care coordination that can drive critical improvements in beneficiaries’ care
  • Establishes a waiver of the 3-day stay Skilled Nursing Facility (SNF) rule for beneficiaries that are prospectively assigned to ACOs under Track 3
  • Refines the policies for resetting ACO 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.

More than 400 ACOs are participating in the Medicare Shared Savings Program nationwide, serving over seven million beneficiaries. To date, there are 10 shared savings models operating in Pennsylvania.

This is part of the federal government’s transition from volume to value-based care. The transition is coming faster than many anticipated.

How can you get prepared and make sure you’re ahead of the curve in the volume to value transition?

Through a series of six online, on-demand courses and live workshops, the Pennsylvania Medical Society (PAMED) is offering CME to ensure Pennsylvania physicians and their health care teams have the skills necessary to succeed in the transition to value-based delivery systems. Learn more about this series and register.