Representatives Diane Black (R-TN) and Peter Welch (D-VT) introduced bipartisan legislation last week that would aim to improve the accountable care organization (ACO) program.
The ACO Improvement Act (H.R. 5558) aims to improve Medicare ACOs with three themes: adding incentives that emphasize health outcomes over services performed, increasing collaboration between patients and doctors, and providing ACOs with additional tools for success. It was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce.
For the first theme, Black and Welch advocate for permitting qualifying ACOs to provide telehealth and remote patient monitoring services. They also ask for regulatory relief that will allow qualifying providers to make healthcare decisions solely based on what is best for the patient.
In terms of increasing patient-doctor collaboration, Black and Welch say ACOs should be able to reduce seniors out-of-pocket expenses for primary care visits and exams to encourage participation in their own wellness. For the last theme, providing ACOs with additional tools needed for success, the legislation would ensure that ACOs have fair and transparent benchmarks and improved data sharing between the Centers for Medicare and Medicaid Services (CMS) and the ACO.
“It is unfortunate that the current fee for service payment system does little to encourage and incentivize providers and patients to use the most appropriate and effective health care options. By incentivizing providers to focus on improving health care outcomes instead of increasing the quantity of services provided, this legislation will help improve care coordination, increase efficiency, and mostly importantly, ensure the patient receives the best care possible," Black, a former nurse, said in a statement.
The legislation comes at a time when Medicare Pioneer ACOs are leaving the program. Even as the CMS announced an estimated total model savings of over $96 million over the program’s two-year span, many ACOs have found the requirements of the program to be too rigid and “financially detrimental.”