(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 266
ACOs, especially physician organized ACOs and smaller ACOs in rural areas, from
participating in the program. In contrast, a lower MSR would encourage more potential
ACOs to participate in the program, but would also provide less confidence that savings
are a result of improvements in quality and efficiency made by an ACO.
We believe that the most appropriate policy concerning determination of the
"appropriate percent" for the MSR would achieve a balance between the advantages of
making incentives and rewards available to successful ACOs and prudent stewardship of
the Medicare Trust Funds. For the one-sided model we are proposing a sliding scale
confidence interval (CI) based on the number of assigned beneficiaries. The MSR would
be established for each ACO based on increasing nominal confidence intervals for larger
ACOs so that an ACO with the minimum 5,000 assigned beneficiaries would have an
MSR based on a 90 percent CI; an ACO with 20,000 assigned beneficiaries would have a
MSR based on a 95 percent CI and an ACO with 50,000 assigned beneficiaries would
have an MSR based on a 99 percent CI. In addition, the MSR would not be allowed to
fall below 2 percent for larger ACOs.
An ACO that exceeds its MSR would be eligible to share up to 50 percent of the
savings in the one-sided model (based on quality performance), as discussed in section
II.E. of this proposed rule. Table 6 displays the minimum savings rate an ACO would
have to achieve before savings could be shared based on the number of its assigned
beneficiaries.
In order to improve the opportunity for groups of solo and small practices to
participate in the Shared Savings Program, we are proposing to vary confidence intervals
by the size of the ACO, which is determined based on the number of assigned