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Spotlight on ACOs

July 30, 2018 | Daily News

The National Association of Accountable Care Organizations wants CMS to create a direct channel for ACOs to report suspected fraud and abuse, but CMS Center for Program Integrity Director Alec Alexander, when pressed on that at a recent hearing, said there are already methods for providers to report such concerns.

July 26, 2018 | Daily News

Representatives from five doctors' groups told the House Energy & Commerce health subcommittee Thursday (July 26) that Congress should retain the Merit-based Incentive Payment System, rather than scrap it as the Medicare Payment Advisory Commission has suggested, as doctors are better off under MIPS than they were under the old Sustainable Growth Rate formula.

July 12, 2018 | Daily News

CMS proposed tweaks to the low-volume exception process for the Merit-based Incentive Payment System, including allowing some otherwise excluded providers to opt-in to MIPS, in a rule released Thursday (July 12), but despite GOP lawmakers' urging, the agency did not lower existing threshold criteria to require more doctors to participate.

June 20, 2018 | Daily News

CMS on Wednesday (June 20) asked stakeholders for feedback on how the physician self-referral law, or Stark law, exemptions are working and what changes are needed to reduce barriers to care coordination for alternative pay models.

June 20, 2018 | Daily News

Hospitals, doctors and health systems groups are asking CMS to give providers more time to decide whether to participate in the new Bundled Payments for Care Improvement Advanced model, given that providers only received important data and information on the model in the beginning of June.

June 13, 2018 | Daily News

HHS Secretary Alex Azar said he is interested in two of the alternative pay models recommended by the Physician-Focused Payment Technical Advisory Committee, and he praised P-TAC’s work.

June 08, 2018 | Daily News

Stakeholders who work with accountable care organizations pushed back against suggestions from Trump administration officials that ACOs need to take on more financial risk, and one stakeholder said he hopes CMS uses an upcoming proposed rule on ACOs to adjust how it handles regional benchmarking and risk adjustment.

June 04, 2018 | Daily News

Avalere says 21 percent of cancer patients in Part B fee-for-service received care in 2017 from doctors participating in the Oncology Care Model -- a demonstration that the Community Oncology Alliance says still falls short even though CMS has addressed some of the group's concerns.

May 03, 2018 | Daily News

The new director of the Center for Medicare and Medicaid Innovation said Thursday (May 3) that he wants to use his new role to reduce regulatory burdens, promote better sharing of data and encourage value-based care through models that would not necessarily involve providers taking on more risk.

May 02, 2018 | Daily News

The White House Office of Management and Budget is looking at a proposed rule that would make changes to the accountable care organization program, including a transition to performance-based risk, more waivers and policies CMS says will make the ACO program sustainable, according to the office's website.

May 02, 2018 | Daily News

White House staff are reviewing a Medicare rule on the Comprehensive Care for Joint Replacement model that accounts for “extreme and uncontrollable circumstances” hospitals in the program might face, and lobbyists familiar with the bundled-pay model says the rule will likely finalize provisions aimed at helping providers affected by natural disasters, such as last year's hurricanes.

May 02, 2018 | Daily News

HHS Secretary Alex Azar said Wednesday (May 2) the president’s drug-cost plan will go further than his budget, but he didn’t say what those additional policies will be.

May 01, 2018 | Daily News

CMS is considering giving Medicare beneficiaries a stipend that they could use to pay for subscriptions to primary care practices that don’t otherwise participate in Medicare, according to James Keese, executive director of the Direct Primary Care Coalition.

April 23, 2018 | Daily News

CMS is considering contracting directly with primary doctors by paying them a lump sum for the primary care services they provide to seniors who volunteer to be part of the pay model.

April 20, 2018 | Daily News

Rheumatologists are developing an alternative pay model to cut rebate-driven pharmacy benefit managers out of the drug channel.

April 17, 2018 | Daily News

Providers are proposing a Medicare alternative pay model aimed at treating opioid addicts that includes both a bonus-only option and an option the creates the prospect of bigger bonuses in return for accepting penalties for poor performance on spending measures for addiction-related services.

April 16, 2018 | Daily News

A bipartisan group of House lawmakers is asking CMS to allow Accountable Care Organizations that are not taking on risk to continue on that track for another three years.

April 11, 2018 | Daily News

The progressive think tank Center for American Progress concludes that efforts by four states -- Massachusetts, Arkansas, Oregon and Maryland -- to rein in health care costs via delivery system reforms instead of cutting eligibility and benefits offer promising models for other states, though the results are mixed.

April 10, 2018 | Daily News

One month after HHS Secretary Alex Azar said accountable care organizations are producing underwhelming results, congressional Medicare advisers signaled a willingness push providers to form two-sided ACOs, encourage more specialists to participate and, perhaps, pave the way for ACOs to become the default for traditional fee-for-service Medicare.

April 02, 2018 | Daily News

The New York health department proposed an alternative pay model that would base provider bonuses in part on estimated lifetime health care savings, which is an unprecedented approach that CMS advisers worry could lead others, such as drug companies, to seek similar treatment.