The final federal language implementing a key Medicare shared savings initiative includes substantial changes that ought to increase provider participation in the program. That’s according to an article by CMS Administrator Donald M. Berwick, MD that appeared in the October 26 New England Journal of Medicine. Under the Accountable Care Organization (ACO) model mandated by the recent healthcare reform law, risk-sharing provider groups can receive a portion of the savings achieved by providing coordinated, high-quality and cost-effective care to seniors. The draft implementing language published last March would have relied on retrospective assignment of beneficiaries to ACOs, holding provider groups accountable for 65 quality measures and requiring that half of network primary care physicians be “meaningful users” of electronic health records (EHRs) by the second year of the program. The final federal rule published in October permits preliminary prospective assignment to ACOs, reduces the number of quality measures to 33 and removes “meaningful use” of EHRs as a condition of participation in the program. “Taken together,” writes Berwick, the changes in the final rule “create a more feasible and attractive on-ramp for a diverse set of providers and organizations to participate as ACOs.” The full text of the article, as a well as a chart demonstrating key changes in the final rule, are available at http://goo.gl/ibccd.