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Spotlight on ACOs

October 19, 2011 | Daily News

CMS has been busy interviewing applicants interested in the Pioneer ACO program and may accept more entities than the 30 or so originally expected, agency chief Don Berwick told reporters following a keynote at the Bipartisan Policy Center's panel on healthcare workforce issues Tuesday (Oct. 18). He would not confirm speculation that the final Medicare shared savings regulation will be out this week, only saying out that it should be out soon. He also discussed a need for the administration and Congress to replace the current Medicare physician payment system.

October 18, 2011 | Daily News

Private plans and Medicaid programs in six states -- including New York and Pennsylvania -- that are already participating in a multi-payer demonstration program will not be eligible to apply for CMS' Innovation Center's newest primary care initiative, according to a CMMI official. Richard Baron, director of CMMI's seamless care models group, said payers involved in a state Multi-payer Advanced Primary Care Practice demonstration that is being run as a state-wide initiative or for the majority of the state will not be able to join the new Comprehensive Primary Care initiative.

October 18, 2011 | Daily News

The Department of Justice and Federal Trade Commission’s proposed accountable care organization antitrust policy statement contains market share calculations that are “beyond difficult” for entities to determine, according to an attorney with clients who viewed the uncertainty as a reason not to participate in Pioneer ACOs. Yet a Department of Justice attorney signaled Monday (Oct. 17) that the two agencies have recognized those difficulties, as stakeholders await a final ACO rule that may be accompanied with a final ACO antitrust policy.

October 17, 2011 | Daily News

CMS on Saturday (Oct. 15) sent an interim final rule on waivers in the accountable care organization program to the Office of Management and Budget for review, with sources saying the rule likely addresses anti-kickback and anti-fraud waivers because CMS' proposed ACO rule left out key decisions on the issue. CMS is also expected to release as soon as this week its final ACO rule, and the Federal Trade Commission and the Department of Justice likely will release revised anti-trust guidelines at the same time.

October 13, 2011 | Daily News

CMS will allow Pioneer ACOs 100 percent capitation by the third year of the program, though CMS also includes a 3 percent cut in interim payment and subjects the final payment to quality ratings, according to a document describing alternative approaches to accountable care organizations that the agency is accepting. CMS has responded to many, if not all, of the entities that applied to the Pioneer ACO program, physician and hospital lobbyists said.

September 29, 2011 | Daily News

Several stakeholders upon initial review of CMS' Innovation Center's new comprehensive primary care demonstration are giving it positive feedback, with several sources telling Inside Health Policy that CMS' plan to offer a care management fee to primary care practices on top of fee-for-service payments is an effective tool to improve care. But a physician source said it remains unclear if the proposed fee amount will be enough to achieve the changes stakeholders are looking for.

September 28, 2011 | Daily News

The Center for Medicare and Medicaid Innovation is using its authority under the health reform law to build on the medical home concept by launching a major new primary care initiative that will bring together Medicare, Medicaid and private payers in five to seven markets, with approximately 75 practices in each market, and serving up to 330,750 Medicare and Medicaid beneficiaries over four years.

September 23, 2011 | Daily News

The National Association of Medicaid Directors (NAMD) is urging the super committee to “seize this historic opportunity” to make constructive changes to Medicaid by granting states more flexibility to move beneficiaries -- including dual eligibles -- into managed care programs without first obtaining a waiver or permission from CMS. In a Sept.

August 24, 2011 | Daily News

Hospital and physician advocates are not publicly criticizing the CMS Bundled Payments initiative unveiled Tuesday (Aug. 23), in part because they hope to favorably influence payment rates that have yet to be determined, but they harbor concerns about the concept, industry sources say.

August 24, 2011 | Daily News

The 340B drug discount could offer a way for Medicaid managed care networks and accountable care organizations to reduce costs, and billing-software company CaptureRx has hired former House Energy and Commerce Chair and PhRMA President Billy Tauzin to pull together stakeholders to set the rules for maximizing discounts while curbing drug diversion and avoiding “double dipping” of 340B and Medicaid discounts.

August 08, 2011 | Daily News

CMS' latest results of the Physician Group Practice Demonstration Program, upon which the Accountable Care Organization project is based, reveals that four of the 10 participants will split $29.4 million in bonuses in the final year of the five-year demonstration, although all participants achieved all or almost all of the quality benchmarks. CMS also announced that all 10 groups will continue to participate in the new PGP transition demonstration -- a two-year supplement to the original demonstration.

July 22, 2011 | Daily News

A confidential draft prepared for CMS lays out key specifications that may be used to identify or calculate specific aspects of the agency's Pioneer accountable care organization demonstration -- a demo that has garnered significant stakeholder interest as it allows private payers to include Medicare and Medicaid beneficiaries in ACOs that are broader and more flexible than those outlined in the contested Medicare Shared Savings Program proposed rule.

July 20, 2011 | Daily News

Rep. Michael Burgess (R-TX), who serves as the vice-chair of health for the House Energy and Commerce Oversight committee, tells Inside Health Policy that he appreciates the White House's recent latest effort to ease regulatory burdens by way of an executive order, but remains “deeply skeptical” that things will change. Burgess' comments were in response to the White House's executive order issued last week (July 11) that asked all regulatory agencies, including HHS, to develop a plan to periodically review existing regulations.

July 01, 2011 | Daily News

The American Hospital Association sent a sternly worded letter to HHS Secretary Kathleen Sebelius declaring that the agency must overhaul its regulations and regulatory process in order for hospitals to properly adapt to the clinical integration envisioned by the health reform law's accountable care organization shared-savings plan.

June 30, 2011 | Daily News

Members of Premier's accountable care organization collaborative met with CMS officials this week to discuss the Pioneer ACO demonstration, and as many as 14 of those health systems are expected to submit letters of intent for the demo, Premier Senior Vice President of Public Affairs told Inside Health Policy,which accounts for about half the number of Pioneer ACOs that CMS officials hope to have up and running by fall.

June 30, 2011 | Daily News

It will cost more than $100 million annually to notify Medicare patients that their physicians are participating in accountable care organizations, according to health care consultant Walton Francis. It’s not clear whether CMS or providers would pay the cost of mailing out letters to beneficiaries, but the former HHS director of policy and regulatory analysis said one thing is fairly certain: Few beneficiaries will read them.

June 27, 2011 | Daily News

Center for Medicare chief Jonathan Blum acknowledged Monday (June 27) that CMS has proposed a very aggressive list of quality metrics in its proposed accountable care organization rule, but said the agency feels strongly that the program is not just about lowering costs but also about improving beneficiaries' overall quality of care. CMS wants to make sure the program doesn’t just lower costs through care skimping or avoidance but will actually produce key improvements, Blum said.

June 22, 2011 | Daily News

CMS Administrator Don Berwick this week said he hopes to see broad stakeholder participation in accountable care organizations, and described his vision of ACO participants using a ski slope analogy: Black diamond, or Pioneer, ACOs that are already well on their way to changing care; “blue square” ACOs that are still on the steep side of the learning curve; and green circle ACOs that have little experience with the concept and are worried about the risks involved.

June 20, 2011 | Daily News

CMS is refraining from writing regulations on a health reform law-established option that allows states to create “health homes” for Medicaid beneficiaries with chronic conditions, according to two CMS officials, in order to hear first from states and providers on the best ways to proceed.

June 20, 2011 | Daily News

The Office of Personnel Management has issued a request for information from stakeholders as it implements a health reform law provision directing the office to contract with health insurance issuers to offer insurance through multiple state exchanges. Among other questions, OPM asks if the plans would incorporate delivery system reforms such as Patient-Centered Medical Homes or Accountable Care Organizations (ACOs).

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