(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 37
when looking at the entire group of treated patients) using a set of Medicare specific
quality measures. Improvements in the quality of care provided to Medicare
beneficiaries are determined on the extent to which IHIE participating physicians are able
to reduce the gap between the maximum attainable level for a quality measure and the
baseline performance for the quality measure. We used approximately 14 ambulatory
care quality measures in the first year, growing to approximately 30 in the fifth year.
Quality-contingent shared savings are available with our calculating savings in the
intervention population by comparing actual costs to expected costs for treated
beneficiaries. Expected costs for the intervention group are projected using adjusted
utilization trends from a comparison group. In general, calculated Medicare savings are
the difference between the expected costs and actual costs for beneficiaries in the
intervention group. At least 50 percent of shared savings that are available to be paid for
payment to the site are contingent on quality of care results for the year. Only after
quality of care performance results for a year are determined can the final amount of
shared savings to be paid to the site be determined.
II. Provisions of the Proposed Rule
A. Organization of the Proposed Rule
The remainder of this document is organized as follows: In section II.A. of this
proposed rule, we propose an operational definition of an ACO for purposes of the shared
savings program. In section II.B. of this proposed rule, we put forth proposed eligibility
requirements for an ACO to participate in this program. In section II.C. of this proposed
rule, we propose requirements for an ACO to commit to a 3-year participation agreement
under this program and present a proposal for data sharing with ACOs. In section II.D.