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ACO Final Rule Recognizes Nursing Leadership Roles

Publish Date: 11/23/2011

On November 2, 2011, the Centers for Medicare & Medicaid Services (CMS) published its much anticipated final rule on the design and implementation of the Medicare Shared Savings Program and Accountable Care Organizations (ACOs).  The final rules are intended to help hospitals and health care professionals better coordinate care for Medicare patients through ACOs. 

Under the rules, the Shared Savings Program will reward ACOs that lower their growth in health care costs while meeting performance standards on quality of care and putting patients first.  Provider participation in an ACO is voluntary.

The final rule accounts for many comments CMS received after publishing its proposed rule earlier this year and has been well-received by many trade groups and professional associations.  It reduces the number of quality measures from those originally proposed by about half, and increases financial incentives for participating ACOs. 

In June 2011, AORN submitted comments to CMS on the proposed rules for this Shared Savings Program.  AORN’s comments supported CMS’s vision of a patient-centered care delivery model that improves care while seeking greater efficiencies and savings, but noted that the proposed rule neglected to include the many contributions of nursing in its provisions and parameters concerning integrated practice in general, and the ACO in particular.

The final rule accounts for some of these concerns and clarifies that qualified health professionals, including RNs, will be recognized as leaders in quality assurance and process improvement initiatives within an ACO.   The proposed rule had limited such leadership to physicians.  This recognition of RN leadership is a victory for nursing and an important step toward meeting the recommendations in the recently released IOM report: The Future of Nursing: Leading Change, Advancing Health.

The final rule also recognizes the importance of primary care provided by nurse practitioners and clinical nurse specialists by confirming that patients who receive their primary care from a NP or CNS will be able to continue that care relationship within an ACO.  AORN is pleased that CMS is beginning to recognize the importance of nurses, both in providing direct patient care and in leading health care and quality reform initiatives at their individual facilities.  AORN is hopeful that CMS will continue to value the contributions of nursing in health care quality improvement and reform efforts.

For additional information on ACOs and the Shared Savings Program’s potential impact on nursing, check out these resources from the American Nurses Association. 

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