(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 257
subsequently receives an incentive payment from that program in an ACO performance
year. This is because, all else being equal-- (1) the ACO's expenditures in the
performance year would be higher than they would have been in the absence of the
incentive; and (2) the ACO's expenditures during the benchmark year would be relatively
lower than they would have been had an incentive been received. Conversely, an ACO
would be more likely to share in savings if it received an incentive payment under one of
these other programs in a benchmark year and received no incentive or was penalized
during a performance year. As such, the effect of including these incentive payments in
the calculation of the benchmark and actual expenditures could create perverse incentives
with the result that participation in the Shared Savings Program has the potential to
adversely affect the performance of providers of services and suppliers with respect to
other important Medicare efforts, such as the value-based purchasing and HITECH
initiatives.
Section 1899(b)(3)(D) of the Act provides authority for the Secretary to
incorporate, as the Secretary determines appropriate, the reporting requirements and
incentive payments related to the Physician Quality Reporting System, eRx, EHR, and
other similar initiatives under section 1848 of the Act. The statute provides that these
incentive payments "shall not be taken into consideration when calculating any payments
otherwise made under subsection (d)." Additionally, we believe it is important to ensure
that these various programs' incentives are properly aligned so that their interactions
support rather than impede each of the programs' goals.
Thus, consistent with our statutory authority, we are proposing to exclude
Medicare expenditures or savings for incentive payments and penalties under section