Spotlight on ACOs

CMS on Monday (Jan. 6) touted that about 98% of providers in the Merit-based Incentive Payment System received a bonus or avoided a pay cut for the program’s second performance year, 2018, but some stakeholders say that a budget-neutral system where everyone does well doesn’t provide the necessary incentives to move providers to value-based pay and the program is becoming more of a compliance exercise than motivation for providers to move away from fee-for-service.

Accountable Care Organizations view CMS’ new Direct Contracting demonstration as laying the groundwork for the next generation of ACOs -- particularly with the Next Generation ACO demo set to sunset soon -- and PACE organizations view the Direct Contracting demo as a way to reach new patients who could benefit from the Program of All-Inclusive Care for the Elderly care model.

CMS opened applications for two of its new Medicare alternative payment models on Thursday (Oct. 24) as the Health Care Payment Learning and Action Network (LAN) officially laid out its goals to move all Medicare beneficiaries to value-based pay models by 2025.

A key house panel is poised to mark up this week legislation that slaps a tax on nicotine concentrates used for vaping, and another that lets consumers use tax-free health savings accounts to pay for direct pay primary care arrangements.

While many industry attorneys praise the administration’s proposed Stark Law and anti-kickback statute reforms, some provider groups are skeptical the changes would help make much difference for those navigating the regulations, particularly for those in rural areas, and suggest Congress needs to step in.

Days after CMS unveiled a tool to help employers who are thinking about funding a health reimbursement account that workers can use to buy individual coverage (ICHRA), a private company launched a similar, interactive affordability calculator and administrative platform that can facilitate the new coverage option finalized in July.

Accountable Care Organizations on Friday (Sept. 27) again pushed against a new beneficiary notification requirement that is part of CMS’ ACO overhaul, but CMS says it won’t budge on the requirement just yet.

The National Association of Accountable Care Organizations (NAACOS) called on CMS to pay close attention to what it sees as a dip in the number of new ACO participants for 2019 and lays out recommendations that could help entice new organizations to join the program.

CMS cancelled the Medicare Advantage Qualifying Payment Arrangement Incentive Demonstration due to low participation rates, and some physicians may have opted not to participate partly because there was no ability to access bonuses from the Merit-based Incentive Payment System or the alternative pay models, according to the American Medical Group Association (AMGA).