Spotlight on ACOs

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.

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.

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.

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.

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.

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

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.

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.

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.