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Spotlight on ACOs

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.

May 24, 2011 | Daily News

Several Senate Finance Committee Republicans on Tuesday asked the Obama administration to withdraw its proposed rule on accountable care organizations and craft a new rule that “fulfills the promise of ACOs,” with the request coming as several major health care providers are also raising strong concerns with the rule and prepare to submit formal comments to HHS over the next few days. The GOP lawmakers made the request in a May 24 letter to CMS Administrator Don Berwick and HHS Secretary Kathleen Sebelius.

May 23, 2011 | Daily News

The insurance industry plans to urge CMS to lower the market share threshold for mandatory review of accountable care organizations (ACOs) in health reform's Medicare Shared Savings Program from 50 percent to 40 percent, and to set the safe harbor threshold at 20 percent instead of the 30 percent threshold called for in the draft antitrust guidelines that accompanied the ACO proposed rule, an official with America's Health Insurance Plans told Inside Health Policy.

May 20, 2011 | Daily News

Physician group practice demonstration participants may have little incentive to join CMS' newly unveiled Pioneer accountable care organization initiative due to more favorable terms they have negotiated for round two of PGP, a source familiar with the terms says, but an internal insurance industry analysis shows there are many other clinically integrated entities across country that include private payers, signaling these entities may be well situated for the agency's new bid to combine public and private payers in its Pioneer demo.

May 18, 2011 | Daily News

The use of comparative effectiveness research for choosing treatment may take on a lower political profile if accountable care organizations catch on, sources say. CER naysayers say the research is a way for the government to ration care and get between patients and their physicians, but if physicians in ACOs use the research to find appropriate treatments for their patients, instead of CMS using the research for coverage and payment decisions, the debate over CER may cool, sources say.

May 17, 2011 | Daily News

CMS is strongly encouraging state Medicaid agencies to contract with private clinical entities seeking to become “pioneer” accountable care organizations under a newly unveiled demonstration, and, according to materials released Tuesday (May 17), plans to work with states to see if they need technical assistance to help them pursue such arrangements.

May 17, 2011 | Daily News

CMS will let existing clinically integrated provider groups, which already operate under shared-savings contracts with commercial payers, also contract with Medicare, and eventually Medicaid -- an idea that many health care policy experts have been pushing for a long time to ensure that ACOs succeed.

May 16, 2011 | Daily News

Allowing beneficiaries to opt out of data sharing in accountable care organizations (ACOs) will hinder care coordination efforts under CMS' shared savings program, according to stakeholders drafting comments on the agency's proposed rule, with multiple groups saying major goals of the ACO concept could be impossible to meet if data is withheld. Under the Medicare Shared Savings Program proposed rule, ACOs can only request certain claims data if the beneficiary does not opt out of data sharing and certain notification requirements are met.

May 16, 2011 | Daily News

CMS is slated to announce Tuesday (May 17) accountable care organization demonstrations that will be run through the newly created Center for Medicare and Medicaid Innovations, a move sources say allows the agency to experiment with approaches proposed by stakeholders that don't fit into the contentious ACO proposed rule under the reform law's shared savings program.

May 13, 2011 | Daily News

All 10 participants of CMS' Physician Group Practice (PGP) Demonstration program, which includes some of the most well-known integrated systems in the country, jointly sent a letter to CMS Thursday saying that while they support the goals of accountable care organizations, they have “serious reservations” about the economics and complexity of the agency's proposed rule on the key health reform delivery reform.