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Spotlight on ACOs

March 31, 2016 | Daily News

Providers want Medicare Advantage to count as alternative pay models in the physician-pay system that CMS is developing, but for that to happen, insurance companies would likely have to disclose payment arrangements, providers in MA would have to sign accountable care contract agreements, and CMS would have to true up performance programs, sources say.

March 28, 2016 | Daily News

The White House budget office last Friday began reviewing CMS' major proposed rule on the new Medicare physician-pay system, and some lobbyists speculate the agency will propose the rule late this week while Congress is still on recess.

March 14, 2016 | Daily News

Insurers, hospitals and generic drug lobbyists want CMS to develop common quality measures for value-based reimbursement, but a generic drug lobbyist said it would be difficult to get stakeholders to agree on those measures and a hospital lobbyist cautioned against rushing into new payment policies.

March 11, 2016 | Daily News

When CMS officials announced that they met value-based pay goals, they counted one-sided accountable care organizations as alternative pay models, so ACO lobbyists say they are urging CMS to also consider ACOs that don’t accept the risk of penalties as alternative pay models in the upcoming physician pay system.

March 09, 2016 | Daily News

House lawmakers, including Ways & Means and Energy & Commerce leaders from both parties, as well as Republicans senators raised concerns with CMS' plans to further rely on encounter data in risk adjustment, make other risk adjustment changes and cut payments to Employer Group Waiver Plans, though the House committee leaders like the agency's plan to better target resources for beneficiaries eligible for Medicare and Medicaid.

March 09, 2016 | Daily News

A bipartisan group of House committee leaders believes CMS in the draft 2017 Medicare Advantage and Part D Call letter implicitly recognizes that MA plans could qualify as alternative payment models under a new physician system, though one analyst said CMS has a long way to go before counting Medicare Advantage as an alternative pay model.

March 03, 2016 | Daily News

CMS reached its goal of tying 30 percent of traditional Medicare payments to alternative payment models 11 months ahead of schedule, and some lobbyists say the agency is set to increase the number of Medicare payments tied to value-based pay with the mandatory joint replacement bundle going into effect soon and providers looking to prepare for the new physician payment system.

February 25, 2016 | Daily News

Physician lobbyists plan to pressure CMS to loosen its interpretation of alternative payment models by making their case to the panel that advises the agency on those pay models, and the American Medical Association might seek outside legal help to fight CMS’ stance on what constitutes sufficient financial risk, an AMA executive said Wednesday (Feb. 24).

February 16, 2016 | Daily News

CMS plans to formally request advice on the design of hospital global pay models, said CMS Deputy Administrator and Chief Medical Officer Patrick Conway, who believes global payment models are promising for rural providers.

February 04, 2016 | Daily News

CMS officials indicated this week that they don’t plan to count bonus-only accountable care organizations as alternative pay models in the upcoming physician pay system.

January 29, 2016 | Daily News

The Next Generation Accountable Care Organization Model includes a telehealth waiver that is CMS' attempt to address telehealth inadequacies in Medicare by casting aside two major restrictive provisions, and telehealth advocates think the Centers for Medicare and Medicaid Innovation's new ACO pilot is a good step for telehealth.

January 28, 2016 | Daily News

CMS on Thursday (Jan. 28) proposed changes to ACO performance measures that the agency says would increase bonuses to accountable care organizations by calculating benchmarks based on local health care spending and by limiting the extent to which ACOs must compete against their own past performance.

January 26, 2016 | Daily News

President Obama’s Affordable Care Act is bolstering the Medicare Advantage program that Republicans created, according to an Avalere Health report funded by Aetna.

January 11, 2016 | Daily News

CMS announced Monday (Jan. 11) that 121 new provider groups became Medicare accountable care organizations, but the release also reveals that 64 ACOs dropped out of the Medicare Shared Savings Program and some organizations either dropped out of the Pioneer ACO demonstration or moved to other ACO models.

January 05, 2016 | Daily News

CMS is testing whether paying third parties to line beneficiaries up with social services improves care and reduces spending on clinical services, and an agency official said he hopes the demo convinces provider organizations, such as accountable care organizations, to include social services in their strategies for keeping patients healthy.

January 04, 2016 | Daily News

The White House Office of Management and Budget entered 2016 with 10 CMS rules and notices under its review, ranging from Medicaid home health face-to-face requirements to revised benchmaking methodology for Accountable Care Organizations.

December 08, 2015 | Daily News

Johnson & Johnson wants to include Part D drug spending in the Merit-Based Incentive Payment System, which is part of the new physician pay scheme under development by CMS, because it fears that excluding retail drug spending would cause providers to prescribe Part D drugs when better Part B drugs are available.

November 04, 2015 | Daily News

The head of the accountable care organization trade group says ACOs are interested in CMS' enhanced Medication Therapy Management program, which the agency says should complement the ACOs' work, but that ACOs will want to share in Part D savings if they contract with drug plans.

October 07, 2015 | Daily News

CMS announced Wednesday (Oct. 7) the participants in the dialysis accountable care organizations, and industry expects that later in the week the agency will announce details of the star-ratings program for end-stage renal disease.

September 14, 2015 | Daily News

Hospitals are urging CMS to waive major Medicare restrictions for providers participating in the proposed mandatory bundled-pay program and to put off penalizing hospitals until the third year of the effort.

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