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Spotlight on ACOs

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.

May 11, 2011 | Daily News

More than 90 percent of surveyed members in the American Medical Group Association will not participate in accountable care organizations (ACOs) if CMS does not change its proposed rule on the program, according to a letter AMGA sent CMS on May 11. The association, whose members include physician group practices (PGPs) that inspired the ACO Program, said the proposed rule is “overly prescriptive, operationally burdensome, and the incentives are too difficult to achieve to make this voluntary program attractive.”

May 10, 2011 | Daily News

Rural health care stakeholders are lobbying for a technical correction that would allow Rural Health Clinic physicians and providers to bill under Medicare's physician payment system for the purpose of forming accountable care organizations and qualifying for payment incentives under the Physician Quality Reporting System. A health care consultant familiar with the issues says that Rep. Greg Walden (R-OR) plans to champion the language, which carries a zero score and would likely ride along with the physician pay fix legislation expected at the end of this year.

May 05, 2011 | Daily News

The director of Accountable Care Organization programs for CMS' innovation center said Thursday (May 5) that hospitals that are “heavy handed” in creating their ACO networks will fail because they will not produce desired results. The CMS official said she would “love to see physician-led models” and that it probably would not be the most effective approach to only partner with hospitals to lower expenditures.

May 04, 2011 | Daily News

Pathologists are allowed to be part of accountable care organizations, but for some it may be best for them to remain outside an ACO and instead simply contract with them, according to Lawrence Kocot, deputy director of the Engelberg Center for Health Care Reform. The risks and benefits of contracting with ACOs vary depending on the type of pathology practice, he said.

May 03, 2011 | Daily News

The Wisconsin-based Marshfield Clinic, the biggest financial winner in CMS' physician group practice (PGP) demonstration, likely will not initially participate in the accountable care organization (ACO) program and may transition in later, sources familiar with the Marshfield decision making say. The ACO program is modeled on the PGP demo, and sources say that a decision by Marshfield to stay out of the program would be a strong indication that providers view the ACO proposed rule as too restrictive.

April 25, 2011 | Daily News

Some health organizations may have a head start in forming accountable care organizations because they already fit the criteria in everything but the name, according to a PricewaterhouseCoopers analysis of the recently released regulations governing ACOs. Because much of CMS' draft regulation is based on the CMS physician group practice demonstration, organizations with PGP experience will have a head start adopting the ACO model, the group states in a report called “Stalking the ACO unicorn,” released on Monday.

April 25, 2011 | Daily News

Quality measures in CMS' accountable care organization proposed rule may not be enough to accurately measure whether ACOs' coordinate care and improve health care outcomes, according to Avalere Health's Erik Johnson. However, several provider groups, including Premier Healthcare Alliance, said they like the quality measures in part because they are standardized and tested. Apart from measures that are endorsed by the National Quality Forum, in the proposed rule CMS lists measures that have been used in the Physician Quality Reporting System and the EHR Incentive Program.

April 22, 2011 | Daily News

Industry sources say they are concerned that the requirements for assigning beneficiaries into accountable care organizations are too narrow and could ultimately prevent beneficiaries who only see non-physician practitioners for their primary care from being assigned to ACOs. A provision in the Affordable Care Act required CMS to look at Medicare beneficiaries' use of physician-provided primary care services when determining their assignment to an ACO, rather than also considering services rendered by other health practitioners such as physician assistants and nurse practitioners.

April 21, 2011 | Daily News

The benchmarks for savings in the proposed rule for accountable care organizations (ACOs) will make it difficult for Physician Group Practice (PGP) demonstrations to meet the savings targets because they have already eliminated much of the inefficiencies from their clinically integrated practices, PGP sources say. The approach taken seems designed to entice providers in high cost areas to form ACOs, instead of rewarding groups of efficient providers for doing what they already doing.

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.