The Accountable Care Organization Final Rule may be a 700-page mammoth, but fear not! This presentation will provide you with the highlights you need to know about the Final Rule, including details on the ACO contract with CMS; information on ACOs and FQHCs, Rural Health Centers and Hospitals; required processes and patient-centered criteria; quality and reporting highlights; application details; and more!

1. ACO Final Rule: Highlights Adele Allison, National Director of Government Affairs, SuccessEHS

2. What is the ACO Final Rule?

3. Substantial changes were made to the proposed rules for participating in ACOs. The Final Rule was released on Oct. 20, 2011 .

4. What is an Accountable Care Organization (ACO)? “Groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to the Medicare patients they serve.”

5. ACOs Contract with CMS

6. - Three-year contract term – applies to all stakeholders & participants -Must have sufficient Primary Care Providers and minimum of 5,000 Medicare Physician Fee Schedule beneficiaries

7. -ACO must be a legal entity with a single TIN (taxpayer identification number) -Must have shared-governance with 75% of ACO participants

8. - Payment made to ACO TIN – no authority of distribution downstream -PCPs are limited to participation with ONE ACO (Not intended to be punitive; Exclusivity based upon the PCP’s TIN)

9. - Retain records for 10 years (active ACOs) or 6 years (from date of termination)

10. FQHCs & Rural Health Centers

14. ACOs & Hospitals

19. Required Processes & Patient-Centered Criteria

22. ACO Application & Kick-Off

26. Quality & Reporting – Performance

30. Patient / Caregiver Experience

31. Measure Method of Data Submission Getting Timely Care, Appointments and Information Survey How Well Your Doctors Communicate Survey Patients’ Rating of Doctor Survey Access to Specialists Survey Health Promotion and Education Survey Shared Decision-Making Survey Health Promotion and Education Survey

32. Care Coordination / Patient Safety

33. Measure Method of Data Submission Risk-Standardized, All Condition Readmission Claims Ambulatory Sensitive Conditions Admissions: COPD Claims Ambulatory Sensitive Conditions Admissions: CHF Claims % PCPs that Qualify for EHR Incentive Program Payment EHR Incentive Program Reporting Medication Reconciliation: After Discharge from IP GPRO Web-Interface Falls: Screening for Fall Risk GPRO Web-Interface

34. Preventive Health Measures

35. Measure Method of Data Submission Influenza Immunization - MU Menu CQM and 2012 EHR-based PQRS GPRO Web-Interface Pneumococcal Vaccination - MU Menu CQM GPRO Web-Interface Adult Weight Screening and Follow-up – MU Core CQM GPRO Web-Interface Tobacco Use Assessment and Cessation Intervention - MU Core CQM and 2012 EHR-based PQRS GPRO Web-Interface Depression Screening GPRO Web-Interface Colorectal Cancer Screening - MU Menu CQM GPRO Web-Interface Mammography Screening - MU Menu CQM GPRO Web-Interface Adults 18+ who had BP Measured in previous 2 years GPRO Web-Interface

36. At-Risk Populations

37. Measure Method of Data Submission Diabetes Composite (All / Nothing Scoring): A1c Control (< 8) GPRO Web-Interface Diabetes Composite (All / Nothing Scoring): LDL (<100) GPRO Web-Interface Diabetes Composite (All / Nothing Scoring): BP (<140/90) GPRO Web-Interface Diabetes Composite (All / Nothing Scoring): Tobacco Non-Use GPRO Web-Interface Diabetes Composite (All / Nothing Scoring): Aspirin Use GPRO Web-Interface Diabetes Mellitus: A1c Poor Control (>9) - MU Menu CQM and 2012 EHR-based PQRS GPRO Web-Interface Hypertension: BP Control - MU Menu CQM and 2012 PQRS GPRO Web-Interface IVD: Complete Lipid Profile and LDL Control (<100) - MU Menu CQM and 2012 EHR-based PQRS GPRO Web-Interface IVD: Use of Aspirin or other Antithrombotic - MU Menu CQM and 2012 EHR-based PQRS GPRO Web-Interface Heart Failure: Beta-Blocker Therapy for LVSD - MU Menu CQM GPRO Web-Interface CAD Composite (All / Nothing Scoring): Drug Therapy for lowering LDL-Cholesterol - MU Menu CQM GPRO Web-Interface CAD Composite (All / Nothing Scoring): ACE Inhibitor or ARB Therapy for Patients with CAD and Diabetes and/or LVSD GPRO Web-Interface

38. Quality & Other Reporting

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