Roadmap to the ACO Rule: 25 Key Considerations from CMS's Proposal for Accountable Care Organizations

Embedded within the 400-plus pages of the Centers for Medicare and Medicaid Services' proposed rule for its Medicare Shared Savings Program are a few dozen key considerations for healthcare organizations evaluating the ACO opportunity. This 22-page resource extracts 25 common sense factors to consider while weighing participation in an accountable care organization (ACO) --- whether as a healthcare provider or private payor. This quick reference is a response to the proposed ACO rule issued by CMS in late March, in which an industry expert cuts to the heart of the public payor's proposal and addresses the most common FAQs generated by the controversial proposed rule. While this resource has been developed and timed to assist organizations in assessing the proposal and submitting comments by CMS's June 6 deadline, it is also a useful primer on the ACO integrated health delivery model that should be shared with staff and decision-makers. This abridged look at the CMS proposal addresses the following concerns: Will ACOs really be up and running by January 1, 2012? When does an ACO make sense? Who's eligible to join? What's the time commitment and what happens if you decide an ACO is not for you? What are the steps to formation? What are the guidelines for governance and structure? Who is going to lead the ACO and what are the qualifications of those individuals? How much money is going to be required for ACO startup? How will savings be divided and shared? What's the learning curve? What are the risks? How long before ROI is realized? What is the anti-ACO model and is this a better option for your organization? What is an ACO's defense in a competitive market? What are the business opportunities for commercial payors? What are the pros and cons of ACO risk tracks? Who will lead ACOs? How do you assess an ACO before joining? Why is patient satisfaction important in the ACO Model? What constitutes ACO culture change? What new roles are needed for practice and hospital staff? How will the rule impact developing ACOs? Are there alternatives to ACOs? What are physician staffing requirements in an ACO? Who's likely to succeed in an ACO? What are the ACO's legal hurdles and challenges?