Spotlight on ACOs

CMS agreed on Wednesday (July 10) to turn a tobacco-use quality measure into a pay-for-reporting measure rather than a pay-for-performance measure in 2018 in response to concerns by the National Association of Accountable Care Organizations (NAACOS).

CMS on Wednesday (July 10) proposed a long-awaited bundled pay model for radiation oncology that would replace Medicare’s fee-for-service payments in certain geographic areas.

The White House Office of Management and Budget on June 5 began reviewing highly anticipated changes to the Stark, or physician self-referral, law.

Avalere says about half of providers in the voluntary Oncology Care Model could end up owing CMS money if they join a two-sided risk model with less downside than CMS’ initial offering -- the initial two-sided risk option included in the OCM could lead more than 70% of participants to owe money, according to Avalere’s analysis.

As lawmakers framed the watermark 2015 law that revamped how Medicare pays doctors as a step in the right direction, physician groups bombarded Senate Finance Committee members on Wednesday (May 8) with suggestions on ways to improve the law, including continuing base pay hikes for physicians over the next few years, making the 5% bonus for those participating in alternative pay models permanent and, according to one academic, eliminating the Merit-based Incentive Payment System completely.

CMS says it has an audit strategy in place for the Merit-based Inceptive Payment System, and will conduct audits and data validation this year on providers’ MIPS submissions of 2017 data, coming as the agency continues efforts to recoup incentive funds from the meaningful use of electronic health records program.

CMS Administrator Seema Verma said stakeholders can expect more Center for Medicare and Medicaid Innovation (CMMI) models to be mandatory and for all upcoming payment models to include resources for state Medicaid adoption as she teased new rural health models and a long-awaited radiation oncology model in a speech to the National Association of Accountable Care Organizations (NAACOS) on Thursday (April 25).

HHS on Monday (April 22) announced new models for primary care -- Primary Care First and Direct Contracting -- that are designed to encourage primary care providers to take on more financial risk for the outcomes of their patients and are projected to encompass a quarter of all fee-for-service Medicare beneficiaries.

The National Association of Accountable Care Organizations (NAACOS) recently sent a letter to CMS asking the agency to make a tobacco-use quality measure, which was changed by agency, into a pay-for-reporting measure rather than a pay-for-performance one since NAACOS said CMS didn’t adequately communicate changes and ACO performance scores have suffered.