The dog days of summer may officially be behind us, but things are just starting to heat up over at the Centers for Medicare and Medicaid Services (CMS) with signs that a Medicare Shared Savings Program (MSSP) final rule could be released in the near future. This week, Modern Healthcare is reporting that the Office of Management and Budget (OMB) began their review of the final MSSP rule regarding Accountable Care Organizations on October 5th.  The OMB’s review is one of the final hurdles before a regulation is publicly issued.
Thanks to a busy summer by CMS officials, approximately 1,200 comments were reviewed on the initial proposed MSSP rule.  In the meantime, speculation and anticipation has been constantly circulating throughout the healthcare industry on the possible contents of the final rule and what it means for all parties involved. Here are some of the highlights to catch you up on the summer buzz around accountable care organizations (ACOs):

  • MarketWatch reported that interest in ACOs has now spread from healthcare providers to employers, who believe this new health delivery system will help sustain employer-sponsored benefits without compromising affordability or quality of care.  According to MarketWatch: “This survey of 674 U.S. employers reveals that 28 percent are interested or very interested in exploring ACOs, while 37 percent are somewhat interested, 24 percent are unsure and 11 percent are not at all interested. Quality of care delivered is the top ranked factor by 82 percent of employers in evaluating the use of ACOs. This was followed by the ability to manage the total cost of care (81 percent), patient outcomes (66 percent) and plan/provider pricing transparency (47 percent).”
  • For those of us in the medical device industry, Medical Devices & Diagnostics Industry (MDDI) magazine article “Policy Predictions and Planning for Accountable Care” provides an excellent overview of the ACO model and how manufacturers need to prepare for the inevitable market shift that will result when the rule is published.  MDDI outlines a number of predictions and recommendations for manufacturers to take advantage of this new method for healthcare delivery, emphasizing that “competitive advantage will flow to the medical device companies that study the market issues in order to optimally market products in one to three years.”
  • FierceHealthPayer (FHP) published results from one study conducted by America’s Health Insurance Plans that concludes that existing ACOs provide higher quality and lower costs.  According to FHP, data gathered from the study of eight health plans revealed “approximately 10 percent improvements in quality, a 15 percent decrease in readmissions and total patient days in a hospital, as well as annual savings of $336 per patient.”
  • Individual states also took the opportunity to join the ACO discussions by reporting successes with their current accountable care models. One article by Modern Physician features an ACO in Texas that saw their “doctors performing better than other physicians in the area by 6 percentage points.”  Another, by FierceHealthcare, touts a new partnership taking hold in California between UC-San Francisco, two Catholic Healthcare West facilities, California Pacific Medical Center and Blue Shield of California, which is based on a previous care collaborative model that “produced $20M in savings” and “resulted in a 15 percent decrease in 30-day hospital readmissionsand a 15 percent decrease in length of stay.”

Regardless of what we have seen in the press leading up to the release of this rule, the one takeaway is that the landscape for delivering healthcare is evolving and will continue to evolve in a way that promotes more accountability for providers (and all related parties) to offer the highest quality care for the lowest cost.  Accountable Care Forum will continue monitoring for the soon-to-be-released rules out of CMS and provide analysis of the rules as they becomes available.