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Spotlight on ACOs

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).

June 13, 2011 | Daily News

Quality improvement organizations contend that QIO overhaul ideas floated by the congressional Medicare payment commission run counter to health reform's goals of sharing best practices, including those that could be used to reduce hospital readmissions and hospital acquired conditions, a source at the trade group representing quality organizations says. The Medicare Payment Advisory Commission is considering including the proposals in its June 15 report to Congress.

June 13, 2011 | Daily News

Accountable care organizations (ACOs) and other health reform efforts to spur clinical integration are accelerating the trend of hospitals hiring doctors, according to a new report by the physician search firm Merritt Hawkins. From April 2010 through this past March, 56 percent of the physician job openings were at hospitals, compared with just 23 percent five years ago.

June 09, 2011 | Daily News

Republican Sen. Tom Coburn (OK) on Thursday (June 9) said moving toward accountable care organizations is one of the few positive things to come out of the health law, but that CMS’ widely-panned proposed rule is “idiotic” and an example of how regulations penned by lawyers without intricate knowledge of a subject can sink good policy. The comments on the Senate floor came just days after Oklahoma’s largest health system wrote to Coburn saying it supports the concept of integrated and accountable care but the proposed regulation makes ACOs too difficult too pursue.

June 09, 2011 | Daily News

An association representing some of the largest medical groups in the country is asking the White House budget office to grant CMS more flexibility to alter its controversial accountable care organization rule by locking in the potential savings at the lower end of the spectrum, or at $170 million, rather than the median figure of $510 million that the Office of Management and Budget had reportedly planned to “book” in its mid-session review.

June 07, 2011 | Daily News

CMS is delaying the letter-of-intent and application deadlines for entities interested in participating in the innovation center’s “pioneer” accountable care organization demonstration, a Center for Medicare and Medicaid Innovation official told stakeholders Tuesday (June 7), after providers said they needed more time to apply for the demonstration. Those who want to participate in the Pioneer ACO demonstration must submit a letter of intent by June 30 and the application by Aug. 19, extended from the original deadlines of June 10 and July 18, respectively.

June 07, 2011 | Daily News

The nation's largest seniors organization says that ACOS need to know their assigned population of patients upfront in order to best manage their populations, but adds that CMS needs to ensure no “gaming” occurs by aggressively monitoring behavior.

June 07, 2011 | Daily News

The Medicare Payment Advisory Commission recommends that accountable care organizations be given longer to adjust to a “two-sided risk model” -- an approach that MedPAC invented -- and the commission is also calling for prospective assignment, bigger bonuses, fewer quality measures, risk adjustment and revised benchmarks, the latter potentially requiring legislative changes. Many hospitals and doctors are pushing similar changes to CMS’ proposed ACO rule as a way to encourage ACO participation, but MedPAC cautions against basing the success of the program on initia

June 07, 2011 | Daily News

The health insurance lobby is calling for accountable care organizations under CMS’ Medicare Shared Savings Program to build on the health plan-provider partnerships that are already taking place in the private sector and say CMS’ proposed ACO rule is “too narrow and is at odds with the way successful ACO models are working in the delivery system today.” America’s Health Insurance Plans details its concerns in comments sent to CMS Monday (June 6).

June 07, 2011 | Daily News

CMS will start taking applications from Federally Qualified Health Centers (FQHCs) interested in participating in a medical home demonstration program in which qualified centers that serve at least 200 Medicare beneficiaries will receive monthly payments for coordinating care for Medicare beneficiaries, the agency announced Monday (June 6). The FQHC Advanced Primary Care Practice demonstration is expected to pay up to $42 million over three years for an estimated 500 participating FQHCs, serving up to 195,000 Medicare beneficiaries.

June 01, 2011 | Daily News

The American Hospital Association says CMS lacks the legal authority to issue regulations governing the application of antitrust laws or to delegate to the Department of Justice or the Federal Trade Commission the authority to block certain accountable care organizations, according to the association's comments about the DOJ and FTC draft policy statement on ACO antitrust enforcement. Hospital groups, such as the AHA and the Federation of American Hospitals, say the joint policy statement wrongly turns ACO antitrust enforcement into a regulatory process.

May 27, 2011 | Daily News

Key Washington insiders expect CMS to reject GOP lawmakers' call for the agency to scrap its proposed accountable care organization rule, but predict the agency may wrap major policy changes into the final version of the rule to address a slew of concerns raised by providers. Plus, CMS can point to the flexibility built into the ACO Pioneer model to address issues not resolved in the health reform law's shared savings program rule, health care consultants tell Inside Health Policy.

May 27, 2011 | Daily News

CMS' proposed method of assigning Medicare beneficiaries into accountable care organizations will lead to “gaming of the system” since groups can remove the attribution of patients by intentionally reducing billing by physicians, according to comments a primary care consortium plans to submit to the agency on the proposed ACO rule. Under the agency's plan, beneficiaries would only be assigned to ACOs if they received a plurality of their primary care services, based on allowed charges, from primary care physicians within the ACO.

May 26, 2011 | Daily News

Doctors are at odds with insurance companies when it comes to how the administration should pursue antitrust oversight of accountable care organizations. The American Medical Association wants to increase the market share threshold proposed by the administration that determines when antitrust agencies must scrutinize ACOs, and America's Health Insurance Plans wants the mandatory review threshold reduced.

May 25, 2011 | Daily News

Seventeen CEOs of health systems across the country wrote to CMS Administrator Don Berwick saying that their organizations would be more likely to participate in the ACO program if the final rule allows for prospective attribution, narrows the initial quality measures, makes the shared savings percentages more favorable to providers, and further eases antitrust limits.

May 25, 2011 | Daily News

CMS Medicare chief Jonathan Blum indicated that the agency would give accountable care organizations more time to phase in the two-sided risk model and potentially other requirements in the proposed rule on the Medicare Shared Savings Program. Provider groups and GOP lawmakers have blasted key elements of the proposed rule, and CMS it trying to figure out whether the proposal's requirements are right and providers merely need more time to attain them or are too strict for now and in the future, Blum said at a webinar sponsored by VHA Inc.

May 25, 2011 | Daily News

Sen. Charles Grassley (R-IA) opted against joining a majority of his GOP Senate Finance Committee colleagues in asking CMS to withdraw its proposed rule on accountable care organizations because an Iowa health care system is interested in the Pioneer ACO model that CMS announced last week and the senator did not want to complicate the situation, a source close to Grassley says.

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