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Spotlight on ACOs

April 19, 2011 | Daily News

The nursing home industry wants to be able to participate in accountable care organizations and is also pressing for quality improvement initiatives and “site neutral” payment for post-acute care, American Health Care Association President and CEO Mark Parkinson said Tuesday. Although the industry supported health reform and agreed to take more than $14.6 billion in cuts, Parkinson said nursing homes remain concerned about the employer mandate.

April 13, 2011 | Daily News

CMS Administrator Don Berwick told an audience of hospital representatives that CMS is pushing retrospective assignment of beneficiaries into accountable care organizations as a way to promote overarching reform and prevent potential gaming.

The agency had concerns that if ACOs knew which patients were assigned to them, they'd respond by providing the best care to those beneficiaries, potentially at the expense of other patients, he said. By making assignments on a retrospective basis, ACOs would be encouraged to make true reforms, and offer improved care for all patients.

April 12, 2011 | Daily News

HHS on Tuesday announced plans to invest $500 million in demonstration programs that aim to help people transition from acute care back to other settings and said CMS will start accepting grant applications from eligible hospitals and community-based organizations. Applicants must address how they intend to align their care transition programs with initiatives sponsored by other payers, including Medicaid, Medicare Advantage and the private sector, CMS says. Awardees are also expected to work with accountable care organizations and medical homes.

April 01, 2011 | Daily News

CMS has tapped noted primary care physician leader Richard Baron as Seamless Care Models Group Director at the new Center For Medicare and Medicaid Innovation. Baron tells Inside Health Policy he expects his new role will focus on the relationship between accountable care organizations and primary care physicians, which is integral to making the new system work.

March 31, 2011 | Daily News

CMS and the Office of the Inspector General on Thursday released a proposed framework for granting anti-fraud waivers to accountable care organizations, and a call to stakeholders for comments on several details yet to be worked out.

March 31, 2011 | Daily News

An accountable care organization must meet quality expectations on 65 quality performance measures -- organized under five “domains” -- in order to be eligible for the shared savings, but for the first year ACOs are only required to provide accurate reporting to meet that standard, according to the ACO rule proposed by CMS Thursday. However, the agency does propose to score quality in that first year for informational purposes and to help define the benchmarks for the subsequent years, CMS notes in a fact sheet.

March 31, 2011 | Daily News

The Department of Justice and Federal Trade Commission are proposing to jointly enforce antitrust laws when examining accountable care organizations as created by health reform, with the two agencies releasing a proposed policy statement Thursday (March 31) calling for an antitrust “safety zone” for certain ACOs that would shield them from challenges.

March 31, 2011 | Daily News

A broad coalition of health care stakeholders emphasized collaboration and strong, data-driven assessments in a set of “consensus” recommendations for accountable care organizations released a day before CMS was expected to unveil its long-awaited ACO rule, saying researchers should study health systems that have already produced savings and quality improvements through better coordination of care.

March 24, 2011 | Daily News

A group of Democratic senators continues to press the administration to give the Department of Justice a role in antitrust enforcement of accountable care organizations, with a private antitrust lawyer suggesting DOJ is seen as more likely than the Federal Trade Commission to allow hospital mergers that would make ACOs a powerful force in integrating health care. The lawyer said the White House has more control over DOJ so Democrats might want to give DOJ a shared role with FTC because ACOs are viewed as a key health reform tool to reduce costs and improve health care quality.

March 11, 2011 | Daily News

CMS' long-awaited proposed rule on accountable care organizations will be released within the next two weeks, HHS Secretary Kathleen Sebelius said Thursday (March 10) following a House appropriations hearing. The rule was initially scheduled to be released late last year, but has been delayed multiple times to ensure that CMS “gets it right,” CMS Administrator Don Berwick told insurers earlier this week.

When later asked about Sebelius' statement, an HHS spokesperson said the rule would come out “sometime within the next few weeks.”

February 24, 2011 | Daily News

CMS appears to have punted key decisions regarding anti-fraud waivers associated with creation of health reform's accountable care organizations, and has signaled to stakeholders it may also put off a final decision on whether the Justice Department or Federal Trade Commission should oversee ACO anti-trust concerns, as it prepares to issue a long-awaited ACO rule in the next several days.

February 23, 2011 | Daily News

The Office of Management and Budget is reviewing the highly anticipated health reform law's rule on Accountable Care Organizations, a last step before the proposed rule's release. The rule, which was originally expected to be released late last year before being delayed until mid-January and again until later this month, went to OMB on Feb. 14. There is still no scheduled date for the rule's release.

February 11, 2011 | Daily News

The U.S. Chamber of Commerce recently sent a private letter to CMS Administrator Donald Berwick raising concerns that providers will shift costs onto private insurers and employers insurance as an untended result of Accountable Care Organizations (ACO), a central piece of delivery system reform in the health care law and regulations for which could come out by the end of this month.

February 11, 2011 | Daily News

Utah Republican Gov. Gary Herbert, a staunch opponent of the new health reform law, came to Washington on Thursday to offer priorities for reforming Medicaid, including a stronger focus on accountable care organization and increased use of technology in state Medicaid programs.

February 10, 2011 | Daily News

CMS is considering using CMMI funding to help physician practices develop their own accountable care organizations, CMS' Jonathan Blum said during an American Medical Association forum today. It's not a done deal but the suggestion is being considered, Blum said. He also said that CMS officials understand the providers need to have real time Medicare data sharing, but noted that such information has historically been kept private, so data sharing is a key issue officials are weighing.

February 09, 2011 | Daily News

As CMS gets closer to issuing its much-anticipated proposed rule on health reform's Accountable Care Organizations (ACO), increasingly more attention is being given to the idea of states promoting ACOs and incorporating Medicaid into the model.

February 02, 2011 | Daily News

CMS Administrator Donald Berwick indicated Tuesday that CMS still plans to let accountable care organizations include Medicare beneficiaries and patients with private insurance. Specifically, he said the CMS innovation center will make room for the "vanguards" of accountable care organizations so CMS can test ACO models that go beyond what is called for under the ACO program.

January 27, 2011 | Daily News

Key administration officials will discuss their goals for creating the health reform law's Accountable Care Organizations at a Feb. 1 public meeting hosted by the Brookings Institution, an event likely to be heavily attended by stakeholders who are anxiously awaiting upcoming CMS regulations on the issue. CMS Administrator Donald Berwick will discuss “goals” for ACOs and Nancy-Ann DeParle, counselor to president and director of the White House Office of Health Reform, will discuss “advancing accountable care together,” the agenda states.

January 24, 2011 | Daily News

The White House plans to hold a briefing soon to discuss accountable care organizations and also plans to tout its efforts to stem hospital-acquired conditions, sources say. Patient safety initiatives, including curbing hospital-acquired conditions, could be incubators for larger reforms that aim to improve care and reduce costs, sources say. Washington insiders say behind-the-scenes discussions regarding ACO options have increased in the past few weeks.