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Spotlight on ACOs

January 30, 2014 | Daily News

CMS announced early results from its initiatives on accountable care organizations: Nearly half of the 114 ACOs in the Medicare Shared Savings Program had lower expenditures than expected, 29 of which received bonuses (shared savings) totaling $126 million in the first year and generated $128 million in savings for Medicare; Pioneer ACOs, which are part of a separate initiative, generated gross savings of $147 million in their first year; and the participants of the Physician Group Practice Demonstration earned a total of $108 million in bonuses over five years for improving the quality of care and lowering costs.

January 22, 2014 | Daily News

Thirty-five state Medicaid programs have expanded to reimburse peer-support specialists since 2001, which experts in the mental and substance abuse fields say is a sea-tide of change that could eventually result in validation and creation of a profession that fits well with accountable care organizations and the push for value-based purchasing.

January 03, 2014 | Daily News

The National Quality Forum is speeding its review of quality measures, including those that need to be retired, and NQF and CMS officials are considering changes to how measure-development is funded in anticipation of a flood of new quality measures as Congress and CMS move toward rewarding good care and penalizing poor care, says NQF President and CEO Christine Cassel.

December 27, 2013 | Daily News

Family doctors tout new survey results as part of their bid to keep physician assistants and nurse practitioners from taking responsibility for many of the services for which doctors are responsible.

December 20, 2013 | Daily News

CMS is seeking advice on whether it should expand the pioneer accountable care organization demonstration and wants input on whether to transform ACOs of all types to a “full insurance risk” model like Medicare Advantage plans, whether to add the drug benefit to ACOs and whether to make ACOs accountable for Medicaid outcomes.

November 19, 2013 | Daily News

Medicaid directors are looking toward patient-centered medical homes, with or without an accountable care organization attached, to curb spending and improve the quality of care.

November 19, 2013 | Daily News

The hospital value-based purchasing program leaves more hospitals with pay cuts than bonuses, with about half of hospitals breaking even, according to new CMS calculations of the value-based purchasing payment incentives.

November 13, 2013 | Daily News

The National Nursing Centers Consortium is urging CMS to replace its term “primary care physician” with “primary care clinician” in little-noticed guidelines sent recently to Arkansas on its patient centered medical home plan.

November 08, 2013 | Daily News

Congressional Medicare payment advisers are considering recommending changes for the second round of the Medicare ACO program, but first hope to determine whether accountable care organizations should remain a niche or whether the program should be spread widely.

October 07, 2013 | Daily News

Hospitals -- feeling pressure from tightening payments from government and private payers, and from HHS to beef up systems that base care on quality and volume -- are eagerly turning to insurance-like business models.

September 12, 2013 | Daily News

Congressional Medicare advisers on Thursday (Sept. 12) discussed the prospect of offering ACO beneficiaries Medigap plans with low premiums and reduced cost sharing when they visit in-network providers.

August 30, 2013 | Daily News

CMS is not interested in partnering with states on Medicaid shared savings programs based on cost savings alone, saying the programs must improve quality and health outcomes, according to agency guidance released Friday (Aug. 30) laying out what states need to consider when designing and implementing such initiatives.

August 15, 2013 | Daily News

A little-noticed Arkansas initiative to require most insurers, including those working with exchanges, to participate in a state-wide episode-based pay initiative is viewed as a possible game changer.

July 31, 2013 | Daily News

An elder care center is applying to CMS to test an ACO-like organization that would care for the frail elderly, which some seniors advocates believe could be a model for overhauling the long-term care system to handle the coming wave of dependent elderly.

July 16, 2013 | Daily News

Nine of the 32 pioneer accountable care organizations are dropping out of the program because they didn't produce savings in the first year, and seven of those nine are applying to participate in the separate Medicare Shared Savings Program initiative that lets ACOs operate longer before penalizing them for not reducing spending, CMS revealed Tuesday (July 16).

July 15, 2013 | Daily News

CMS is expected to announce on Tuesday (July 16) the performance results for the first year of the pioneer ACO demonstration and the number of accountable care organizations dropping out of the demo, physician lobbyists say.

June 28, 2013 | Daily News

Just fewer than 10 of the 32 pioneer ACOs either are dropping out of the demo or are considering doing so, and the four or five that are dropping out of the program are moving to a separate accountable care organization program, called the Medicare Shared Savings Program (MSSP), which does not punish ACOs for failing to meet cost and performance goals, a CMS source tells Inside Health Policy.

June 20, 2013 | Daily News

Sen. Ron Wyden (D-OR) said he hopes Congress will repeal a regulation that requires accountable care organizations accept all patients, which is a rule House Democrats insisted on to keep ACOs from cherry picking healthier beneficiaries and avoid making beneficiaries feel that ACOs limit their choice of providers.

June 03, 2013 | Daily News

CMS again is extending the deadline for Pioneer ACOs to decide whether they will stay in the high-profile health reform demonstration and is verifying with accountable care organizations the first-year performance results from the demo, on which pay will be partially based, an agency spokesperson said.

May 31, 2013 | Daily News

Rick Gilfillan, director of the CMS Innovation Center, will leave the agency at the end of June and will be temporarily replaced by Patrick Conway, according to an internal e-mail from CMS Administrator Marilyn Tavenner obtained by Inside Health Policy.