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Spotlight on ACOs

January 22, 2011 | Daily News

The White House held discussions with stakeholders last year about the possibility of CMS assigning Medicare and possibly Medicaid beneficiaries to existing clinically integrated entities in the private insurance market, which many consider the equivalent to what will be accountable care organizations (ACOs), but an expected post-election announcement never occurred. Stakeholders say it’s no longer clear whether CMS will move on the policy any time soon or whether the idea will be broached at a White House ACO briefing expected to take place next week (see story).

January 22, 2011 | Daily News

Providers in the physician group practice demonstrations are urging CMS to loosen the cost-cutting threshold as they negotiate the next round of PGP demonstrations, arguing that it is too difficult to continue reducing costs by more than 2 percent after five years of lowering costs, sources say. CMS is expected to let the PGPs apply to become accountable care organizations once the ACO program is running, which is supposed to be next year, even though the PGP demonstrations will run for three years.

January 22, 2011 | Daily News

People should know they are in accountable care organizations and they should be allowed to opt out of them, even though those who don't opt out are not required to use doctors in the ACO network, Premier is telling CMS. In return, a Premier source says, CMS should let ACOs market to beneficiaries once they've opted in, as part of a bid to keep patients in network, and should be allowed to monitor the care of patients in ACOs.

January 07, 2011 | Daily News

Three groups are sharing their accountable care organization models as a way to inspire other ACO groups across the country that are forming in advance of CMS' final rule governing how the groups will operate. The three groups published their approaches in Thursday's issue of Health Affairs, focusing on collaboration between providers and insurers, flexibility and accountability in care.

January 03, 2011 | Daily News

Pharmacies are urging CMS to require that accountable care organizations use medication therapy management -- a service that pharmacists provide -- as a way to recognize pharmacies in ACOs. The health reform law allows hospitals and doctors to share savings under Part A and Part B, but shared-savings schemes do not apply to the drug benefit (Part D) so ACOs would have to agree to share savings with pharmacies through contract or employment arrangements with pharmacists, a pharmacist source says.

December 30, 2010 | Daily News

The implementation of accountable care organizations and the expansion of information technology will be among the issues facing the health reform industry in 2011 as the implementation of the new law moves forward, according to a PricewaterhouseCoopers Health Research Institute report.

December 28, 2010 | Daily News

Physician advocates are urging CMS to use already established principles for creating accountable care organizations as a basis for forming the patient-centeredness criteria of the upcoming ACO regulation. CMS solicited stakeholder comments earlier this month to help guide staff as they craft the much-anticipated regulations defining an ACO, which are expected to be released in January.

In the call for comments, CMS asked stakeholder the following: “What aspects of patient-centeredness are particularly important for us to consider.”

December 21, 2010 | Daily News

Some provider organizations have volunteered to take a financial risk if the agency decides to follow the Medicare Payment Commission's call for a “two-sided risk” model for accountable care organizations, but an agency official warned Monday that this model might provide an advantage for larger provider organizations with enough capital to cope with the financial risk.

December 14, 2010 | Daily News

Physician and hospital advocates are urging CMS to use the widely accepted National Quality Forum-endorsed quality measures to evaluate the performance of health reform's accountable care organizations, while patient advocates, along with the Medicare Payment Advisory Commission, urge CMS to also include patient experience assessments.

December 09, 2010 | Daily News

CMS is facing pressure to back off the idea of using a retrospective beneficiary assignment process as it shepherds the establishment of accountable care organizations, with Congress' Medicare Payment Advisory Commission, AARP and other key stakeholders instead advocating prospective assignment under the health reform delivery model.

December 04, 2010 | Daily News

CMS Administrator Donald Berwick said on Friday that the accountable care organization proposed rule – initially planned to be issued later this month – has been pushed back to mid-January at the earliest. Berwick made the announcement the same day the comment period ended for the agency's request for information from stakeholders on key issues surrounding formulation of the ACO proposed rule mandated by health reform.

December 03, 2010 | Daily News

Congress' Medicare Payment Advisory Commission is urging CMS to strengthen incentives for Accountable Care Organizations to improve quality and save money by proposing that the organizations not just receive bonuses for good performance, but also face penalties when they don't cut costs. If CMS believes it can't implement such an approach under the health reform law's shared-savings program, MedPAC says, the agency should test out the idea under ACO demonstrations shepherded by the law's new Center for Medicare and Medicaid Innovation.

November 29, 2010 | Daily News

As CMS puts the finishing touches on its accountable care organization proposed rule, a bipartisan group of 17 House lawmakers is asking the agency to let specialists form ACOs, if those specialists also provide primary care. A recent Congressional Research Service report also broached the idea of specialty ACOs.

November 18, 2010 | Daily News

The insurance and the hospital lobbies plan to hold a joint meeting with CMS officials next week to review existing accountable care organizations (ACOs) in the private sector and discuss ways to ensure the agency's upcoming rulemaking does not undermine those operations.

Karen Ignagni, president and CEO of America's Health Insurance Plans (AHIP), and Richard Umbdenstock, president and CEO of the American Hospital Association, discussed the pending meeting during a panel at the National Business Coalition on Health's conference on Monday.

November 17, 2010 | Daily News

CMS is seeking help from physicians on ways to ensure that small physician practices can participate in Accountable Care Organizations, as physicians are likewise urging CMS to include physicians in “all practice sizes” in the new ACO models by removing resource and anti-trust barriers. The agency raised the topic on a short list of key unresolved issues for which it is seeking stakeholder input as it drafts a proposed rule on the formation of health reform-created ACOs.