The final rule for Medicare Shared Savings Program ACOs, released yesterday by the Centers for Medicare & Medicaid Services, includes changes that are a step in the right direction for the hospital field, but the rule could've gone further to attract hospital participation.

"Overall, we were pleased that CMS made some improvements to the program," said Melissa Jackson, senior associate director of policy with the American Hospital Association. "It's clear they are very interested in retaining participants in the program, and attracting new participants."

The rule allows participants providing care in the most basic version of an ACO — Track 1 — the option to re-up on for another three years. CMS was considered reducing savings for participants continuing on that track, but the final rule does not go that far. That decision is important because 99 percent of the more than 400 MSSP participants serving 7 million beneficiaries are in Track 1. "They need more time to learn how to do this program well before they move on to take advanced risk," Jackson said.

Last month, Health & Human Services released results showing that another Medicare ACO model, the Pioneer ACO program, saved $384 million over two years.

The CMS MSSP rule also should make it easier for MSSP participants to gain access to data needed for quality improvement and care coordination. AHA officials are disappointed that the different risk-reward balances offered by the MSSP ACOs are not reworked to encourage more hospital participation. "Providers, including hospitals, are investing significant resources to do things like develop infrastructure, and learn how to better manage care, and the program as it's structured doesn't allow a huge opportunity for reward," Jackson said.

And more could be done to remove some of the barriers to providing the kind of care sought after by CMS under the model. CMS agreed to waive the three-day inpatient stay minimum for a patient to qualify for skilled nursing facility care, but did so for only the highest-level ACO in the program, Track 3.

"We find it extremely concerning that CMS was not willing to extend certain payment waivers to ACOs, despite a plurality of commenters recommending this course of action," said Premier health care alliance spokesman Blair Childs, in a statement. "This is a serious problem that will need to be addressed in future rule making," Childs said.

Despite some shortcomings to the MSSP program in its current form, Jackson said that the hospital field continues to show interest in the ACO model. "Our members are very enthusiastic about this," she said.