decisionhealth Newsletters, Part B News - 2011 Issue 10 (October)
Top changes to the ACO final rule
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Article Overview
This article summarizes major CMS revisions to the accountable care organization (ACO) final rule. It is relevant to physicians, practice administrators, specialists, and coders who need a plain-language view of the policy’s participation requirements, quality reporting expectations, EHR-related conditions, patient attribution approach, and payment model changes. The discussion focuses on broad operational and program changes rather than detailed coding guidance.
Why This Topic Matters
ACO policy changes can affect how practices participate in shared-savings programs, coordinate care, document quality performance, and determine which clinicians and patients are included in the model. Understanding the broad rule changes helps organizations assess readiness and participation impact.
Article Sections
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Payment models
This section outlines the main ACO payment structure changes described in the article, including participation tracks, shared-savings concepts, and support related to program start-up costs.
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Reporting and quality requirements
This section covers changes to measure counts, domain structure, and the phased approach to reporting expectations under the ACO rule.
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EHR participation requirements
This section discusses how EHR-related participation conditions were revised and how they relate to quality measurement.
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Advanced identification of ACO patients
This section explains the shift in when patients are identified for ACO participation and the general purpose of providing patient lists to ACOs.
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Specialists get credit for primary care services
This section addresses situations in which specialists may be recognized for delivering primary care services within the ACO framework.
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Other improvements in the ACO rule
This section summarizes additional changes to attribution participation and bonus-related provisions mentioned in the article.
What You Will Learn
- How CMS updated ACO participation tracks
- What changed in ACO reporting and quality expectations
- How EHR-related participation conditions were revised
- How patient identification timing changed in the ACO model
- What kinds of clinicians may receive credit for primary care services
- What other ACO rule changes were highlighted by the article
Who Should Read This
- Physicians
- Medical practice administrators
- Healthcare compliance staff
- Medical coders and billing staff
- Specialists participating in ACOs
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