(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 104
alternative approaches that would provide flexibility to program applicants. For instance,
we could allow ACOs to apply on a 'rolling' basis in which applications are accepted and
evaluated any time of year and the ACO's agreement period would begin after a
determination that the eligibility requirements had been met. In this way, applicants
could apply throughout the course of the year as they become ready and we could review
and approve applications and begin performance periods on a rolling basis.
After exploring the various alternatives, it has become clear that the greatest
barrier to any option other than an annual uniform start date relates to appropriate
beneficiary assignment, particularly for markets where there may be multiple ACOs.
First, if ACO agreements begin more often than once a year, beneficiaries could be
assigned to two ACOs for an overlapping period. As discussed in section II.D. of this
proposed rule, we propose that beneficiaries will be assigned to ACOs based upon where
they receive the plurality of their primary care services. Since the physician associated
with the plurality of a beneficiary's primary care services could vary from year to year,
having multiple start dates could result in a beneficiary being assigned to multiple ACOs
for an overlapping period. This scenario would result in confusion for beneficiaries and
the potential for duplicate shared savings payments for care provided to a single
beneficiary. Problems with patient assignment may cause unintended consequences for
per capita costs, making it difficult to make comparisons of one ACO's performance to
another that has a different start date. In addition, adopting multiple start dates within a
year would require multiple cycles for application review and approval, calculation of
baselines and targets, data sharing, quality reporting, and financial reconciliation, which
would impose a significant administrative challenge.