ACO Final Rules Ease Requirements, Reduce Risk

Updated: 10/21/2011 7:20 AM ET.

Federal health, trade and anti-trust agencies on Thursday released their long-awaited set of final rules governing accountable care organizations, with major concessions to the original plan that had soured many healthcare leaders and physicians against participating.

The 696-page document, 267 pages longer than the proposed rule, includes more generous shared savings incentives, omits 32 of the 65 original quality measures, and gives ACO candidates more time to get started.

A critical change is that the rule no longer requires that 50% of participating physicians be approved under meaningful use requirements for electronic health record use.
Compared with the proposed rule, there are many more opportunities for new ACOs to participate without absorbing risk in the earlier years, as well as major changes in at least 10 other critical areas, revisions that many health leaders think will encourage more providers to sign up.

Significantly, each ACO will now know prospectively, instead of retrospectively, who their included beneficiaries are, and will be able to contact them, which they could not do before. As before, however, beneficiaries will be able to opt out of the program as well as seek care outside of the ACO.

Donald Berwick, MD, administrator for the Centers for Medicare & Medicaid Services, said during news briefing that multiple federal agencies made the changes in response to "mountains of comments" and many meetings with providers and patient groups since the proposed rule was released March 31. Coordination with multiple branches of government such as the Department of Justice, the Internal Revenue Service and the Federal Trade Commission were required to iron out concerns about the potential for ACOs to dominate a market.