On Nov. 12, 2010, the Centers for Medicare & Medicaid Services (CMS) posted a notice (to appear in the Federal Register on Nov. 17) seeking comments regarding certain aspects of the policies and standards that will apply to accountable care organizations (ACOs) participating in the Medicare program under Section 3021 or 3022 of the Affordable Care Act.

Comments must be received by 5 p.m. EDT on Wednesday, Dec. 8, 2010.

CMS is seeking comment to help it further develop its initial regulations—which were scheduled to be issued in late December—for the shared savings program and ACOs. The agency’s request for input is a mixed blessing. On one hand, it gives the industry an opportunity to positively influence the drafting of the regulations. On the other hand, the timing of the request suggests that CMS is unlikely to publish the ACO regulations by the end of this year.

In its notice, CMS is seeking additional information, particularly from physicians, on the following:

  • What policies or standards should CMS consider adopting to ensure that solo and small practice providers have the opportunity to actively participate in ACOs?
  • What payment models, financing mechanisms, or other systems should CMS consider to assist small practices to fund efforts from which “shared savings” could be generated?
  • Should beneficiaries be attributed to an ACO before the start of the performance period or at the end of the performance period?
  • How should CMS assess beneficiary and caregiver experience of care as part of ACO performance?
  • What aspects of “patient-centeredness” are particularly important for CMS to consider and how should they be evaluated?
  • What quality measures should CMS use to determine performance in the shared savings program?
  • What additional payment models should CMS consider under the shared savings program?  

CMS is requesting assistance from the industry to help craft regulations that can achieve the congressional vision for ACO development. Those interested in creating an ACO can use this opportunity to explain the legal and practical challenges of organizing and operating a shared savings program and how the regulations might help or hurt the process.