Medicare’s Accountable Care Organization Regulations
How Will Medicare Beneficiaries who Reside in Medically Underserved Communities Fare?
Author(s): Sara Rosenbaum, JD; Peter Shin, PhD, MPH The George Washington University School of Public Health and Health Services Department of Health Policy, 2011
On March 31, 2011, the Centers for Medicare and Medicaid Services (CMS) released proposed regulations implementing the Medicare Shared Savings Program (MSSP). The thrust of the MSSP is to promote savings to Medicare as well as the greater clinical integration of health care through incentive payments to accountable care organizations (ACOs) that meet Medicare standards for structure, performance, and health care outcomes. The effort to spur greater clinical integration through the MSSP was part of a broader set of reforms contained in the Affordable Care Act (ACA) whose aim was to improve health care quality and efficiency. Among these reforms is an $11 billion investment in community health centers, known as federally qualified health centers (FQHCs) under the Medicare program. In 2009, health centers served nearly 19 million low-income patients, including 1.4 million Medicare beneficiaries. By law, health centers must provide comprehensive primary health care while also serving as gateways to a full range of necessary care, including inpatient and specialty care. Federal data on health center services show that primary care represents 98.2 percent of all health care furnished by FQHCs.
