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Spotlight on ACOs

March 26, 2012 | Daily News

It looks as if many of the states that planned to take part in the “duals” demonstration, which aligns payment between Medicare and Medicaid for residents covered by both of those programs, will have to sit out the demo because they cannot meet the deadlines, sources tracking the demo say. States that plan to participate must post their proposals on state websites for public comment within the next couple of weeks in order to meet their deadlines for submitting those proposals to CMS, and most have not.

March 10, 2012 | Daily News

A CMS official speaking at the National Association of State Health Cooperatives (NASCHO) suggested that accountable care organizations (ACO) would make good partners for the new Consumer Oriented and Operated Plans (CO-OPs), which were established under the health law as non-profit competitors to insurers. Barbara Smith, the agency's key point person for the CO-OPs, told the audience of interested stakeholders that ACOs present an opportunity because many are looking for organizations who could step in and help bear some of the risk.

March 08, 2012 | Daily News

CMS asked all Pioneer Accountable Care Organization participants to review their provider lists and submit a final, correct list to the agency by mid-February following an incident in which two California participants sent letters to Medicare patients of several providers who had not agreed to join the ACO, according to documents obtained by Inside Health Policy.

January 23, 2012 | Daily News

Multi-specialty medical groups are urging congressional conferees to hammer out a longer-term Medicare physician payment solution that takes physician practice costs into account and rewards providers for delivering quality care. As conferees prepared to launch talks Tuesday (Jan. 24), the American Medical Group Association (AMGA) asked lawmakers to reject additional short-term fixes, warning a continued threat of payment cuts could thwart health reforms such as accountable care organizations and physician quality efforts.

January 19, 2012 | Daily News

On the same day that Premier announced its QUEST initiative saved more than 24,000 lives and nearly $4.5 billion over three years, the Congressional Budget Office said Medicare demonstrations that build on the kind of data sharing and medical-practices development engendered by QUEST showed no evidence of reducing Medicare spending.

January 11, 2012 | Daily News

Advocacy group Families USA on Tuesday (Jan. 10) unveiled two new reports that aim to provide state-based consumer advocates a roadmap for monitoring state efforts to institute accountable care organizations and other delivery system reforms, and the group lays out specific questions it says advocates should ask to ensure ACOs in their area are committed to providing coordinated services that not only lower cost but also improve care.

December 19, 2011 | Daily News

CMS has chosen 32 health care systems to participate in its Pioneer ACO demonstration, projected to save Medicare $1.1 billion, out of 80 applicants that had been part of a group of some 160 systems that signed letters of intent, CMS officials said Monday (Dec. 19). Three of the Pioneer accountable care organizations were from the group of 10 physician groups that comprised the physician group practice demonstration upon which ACOs are modeled.

November 17, 2011 | Daily News

At least two Physician Group Practice Demonstration sites -- Park Nicollet Health Services and University of Michigan Health System -- are considering switching over to the Pioneer ACO Demonstration, sources say, despite earlier reports that PGPs would likely not be interested in switching.

November 15, 2011 | Daily News

The National Committee for Quality Assurance's new accountable care organization accreditation program will evaluate entities across seven domains and has initially identified 40 measures for reporting, while also including multiple accreditation levels to accommodate ACOs that are at different stages. NCQA President Margaret O'Kane said the accreditation program, which will be officially launched Nov.

November 14, 2011 | Daily News

CMS may delay the March 15 deadline for submitting applications for three of the bundled payment models to give interested entities time to review Medicare claims data so they can suggest payment rates, according to hospital sources. Interested entities have already submitted letters of intent for the bundled payment models, but in order to know whether they are going to apply for the initiative, they must know the payment rates, and they cannot suggest payment levels to CMS until they've review Medicare claims data that they hope to receive from CMS in a matter of weeks.

November 12, 2011 | Daily News

The issue of states rights is splitting Republicans on medical malpractice reform, which Washington insiders say faces long odds in the super committee despite a push from the physician community and the backing of key GOP lawmakers. Trial lawyers and constitutional conservatives have further complicated an already tough issue by turning some Republicans against federal caps on liability damage awards by playing up states' rights concerns.

November 10, 2011 | Daily News

Three GOP Senate Finance Committee members are calling on HHS and the Government Accountability Office to examine the role of the health reform law's Center for Medicare and Medicaid Innovation, seeking a full probe of CMMI's activities and their fiscal impact on the two health programs. The requests, in Nov.

November 10, 2011 | Daily News

Families USA and dozens of other associations are worried the debt law's super committee might impose some form of triggered cap or limit on expenditures for beneficiaries dually eligible for Medicare and Medicaid, and will soon send a letter to the panel urging it to ensure such beneficiaries are not adversely affected by deficit reduction policies. The letter, slated to be sent Friday (Nov. 11), will also come out against calls by state Medicaid directors and managed care plans for mandatory enrollment in managed care, saying the proposal is a “bad idea.”

November 10, 2011 | Daily News

The advance-payment demonstration for the accountable care organization program will pay for up to about three-quarters of ACO start-up costs and roughly one-third of the cost to maintain the program thereafter, and that -- combined with an ACO track without the risk of penalties -- will likely be sufficient to get some rural and small- to mid-sized physician groups that are keen on ACOs to participate in the program, according to representatives of physician groups that asked CMS for the demonstration.

November 02, 2011 | Daily News

CMS averted a possible lawsuit from hospitals by suspending the effective date for three of the value-based purchasing measures that were slated to be included in the program in fiscal year 2014. The American Hospital Association had warned the agency that moving forward with the deadline would have conflicted with the health law's requirement that all measures be posted on Hospital Compare prior to the start of the performance period.

October 28, 2011 | Daily News

The Senate Committee on Health, Education, Labor and Pensions is looking at holding a hearing within the next two weeks on health-related delivery system reforms, which would give GOP lawmakers a chance to raise ongoing concerns about the direction of CMS' Innovation Center, a GOP aide tells Inside Health Policy.

October 25, 2011 | Daily News

The American Hospital Association is considering litigation related to the health reform law's value-based purchasing program because of what it describes as CMS' failure to follow statutory requirements on posting information about particular VBP measures on the Hospital Compare web site, according to an AHA source.

October 21, 2011 | Daily News

CMS will now allow Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to lead accountable care organizations, a reversal of course generally welcomed by stakeholders who had worried that CMS' earlier proposal would have kept the potential benefits of the ACO model away from people living in medically underserved areas. HHS Secretary Kathleen Sebelius has also decided to use her authority to allow Critical Access Hospitals that use a certain billing method to form ACOs.

October 21, 2011 | Daily News

CMS' Pioneer demonstration still offers accountable care organizations the potential for bigger bonuses and losses than the Medicare Shared Shavings Program ACO rule unveiled Thursday (Oct. 20), said Richard Gilfillan, head of CMS’ innovation center, though CMS made changes in the final ACO shared savings rule to allow for greater rewards, including “first dollar” savings for all ACOs and to let ACOs choose a track that does not include penalties for missing quality and savings goals.