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Accountable Care Organizations See Final Regulations

(October 26, 2011)

Accountable Care Organizations (ACOs) have been in the news ever since being included in the Obama administration's plan for national health reform. Final regulations for ACOs were released October 20, 2011, by the Centers for Medicare and Medicaid Services (CMS). The regulations are less burdensome than those proposed because half as many quality measures are required (linked to financial rewards) and there are fewer legal barriers, such as less antitrust scrutiny. However, all Physician Quality Reporting System (PQRS) measures must be reported in order to receive related incentive payments. Audiologists and speech-language pathologists are already participants in the PQRS.

The Patient Protection and Affordable Care Act (ACA), in its Shared Savings Program (section 3022), promotes the formation of ACOs. ACOs are a method of integrating local physician group practices with other members of the health care system and rewarding them for controlling costs and improving quality (i.e., "shared savings"). Shared savings payments would be distributed to ACO participants (physicians and hospitals) as well as providers/suppliers of services based on negotiation and the ACO's determination "how to equitably distribute shared savings or use the shared savings to meet the goals of the program."

CMS expects that an ACO will typically include primary care physicians, specialists, and a hospital, although hospital participants are not required. The flexibility in the law allows ACOs to accommodate a range of physician provider organizations including multi-specialty group practices, physician hospital organizations, and independent physician associations. The ACO may provide rehabilitation services with in-house staff or contract with rehabilitation provider organizations. It is expected that an ACO will prefer to contract with a single rehabilitation organization rather than increase administrative bulkiness by contracting separately with speech-language pathology, physical therapy, and occupational therapy organizations. Audiology services could be incorporated into rehabilitation contracts, by independent audiology contracts, or arranged through otolaryngology practices that are ACO participants.

ASHA submitted comments in response to the proposed ACO regulations issued on April 7, 2011. ASHA urged CMS to require ACOs to:

  • Make speech-language pathology and audiology services accessible to patients. CMS responded that market forces will determine the need for the range of services offered.
  • Allocate an equitable portion of shared savings to speech-language pathologists and audiologists. CMS stated that it does not have legal authority to dictate how shared savings are distributed.
  • Encourage the use of telehealth services provided by audiologists and speech-language pathologists. In response, CMS announced that it is preparing a separate incentive package, not limited to ACOs, which includes telehealth services beyond what is currently reimbursed under fee-for-service Medicare.

ASHA will continue to analyze the impact and restrictions of operational ACOs. CMS allows flexible start dates in 2012. For further information, contact Mark Kander, ASHA's director of health care regulatory analysis, by e-mail at

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