“Pathway to Success” proposes to overhaul Medicare’s Accountability Care Organizations

What’s Happening?

The Center for Medicaid Services (CMS) has proposed new rules dubbed “Pathway to Success” for Accountability Care Organizations (ACOs). ACOs cover 10.5 million fee-for-service Medicare beneficiaries

What is an ACO?

ACOs are groups of doctors, hospitals, and other health care providers who come together voluntarily to give coordinated high-quality care to their Medicare patients.

The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings it achieves for the Medicare program.

Why is this happening?

 According to CMS, ACOs are not providing the cost savings results the program was designed to achieve, but rather have shown increases in net spending.  

What does the overhaul mean for you?

The proposed rules would:

  • Require ACO participants to provide a standardized notice letting participants know they are in an ACO at each beneficiary’s first primary care visit of the performance year, in addition to having the same information also available upon request (as currently required). 

  • Certain ACOs will provide incentive payments (up to $20 to an assigned beneficiary for each qualifying primary care service that the beneficiary receives from certain ACO professionals, or from a Federally Qualified Health Center or Rural Health Clinic) to patients for taking steps to achieve good health.

  • Allow beneficiaries to designate a physician regardless of specialty, or a nurse practitioner, physician’s assistant. or clinical nurse specialist as their “primary clinician” responsible for coordinating their overall care.  

The Bottom Line

Pathway to Success proposes to improve the quality of health care for Medicare beneficiaries in fee-for-service plans while reducing the overall cost of healthcare for taxpayers.

By Gus Smith     

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