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Spotlight on ACOs

October 19, 2017 | Daily News

Accountable care organizations in the Medicare Shared Savings Program and three ACO demonstrations collectively saved Medicare $70.6 million in 2016 after ACO bonuses are taken into account, a CMS spokesperson said.

October 05, 2017 | Daily News

Specialists are getting help from House Republican lawmakers in their quest to exclude the cost of drugs they administer from the calculation of their Medicare bonuses and penalties.

October 02, 2017 | Daily News

Specialty doctors are lobbying Congress to exclude the cost of drugs they administer from the calculation of their Medicare bonuses and penalties because the therapies are often expensive and would result in volatile swings in reimbursement.

August 29, 2017 | Daily News

The HHS Office of Inspector General reported Tuesday (Aug. 29) that Medicare accountable care organizations saved the program nearly $1 billion over the first three years of the Medicare Shared Savings Program.

June 20, 2017 | Daily News

CMS proposed Tuesday (June 20) to exempt more doctors from the performance measures of Medicare's new physician pay rule, delay measuring doctor performance on cost, allow doctors in small and rural practices to form “virtual groups,” award bonus points to the performance scores of doctors in small practice and delay a required upgrade to physicians' electronic health record systems.

June 20, 2017 | Daily News

Policies to watch for in the physician pay system regulation that the White House Office of Management and Budget finished reviewing last week include changes to the reporting burden, the resource use component of the Merit-Based Incentive Payment System and virtual groups.

June 14, 2017 | Daily News

CMS told doctors in alternative pay models they all should expect 5 percent bonuses in the first year of the new pay system, which a former CMS official said comes as a relief to doctors who weren't sure they qualify for the bonus and now don't have to worry about their performance in the Merit-Based Incentive Payment System.

April 18, 2017 | Daily News

CMS is asking hospitals applying to participate in the extension of the Rural Community Hospital Demonstration to explain how rural hospital closures have affected them, and whether the applicants are filling gaps left by the closure of other hospitals.

April 18, 2017 | Daily News

The White House Office of Management and Budget is reviewing a CMS proposed rule that offers an opportunity for the new administration to put its mark on the physician pay system under development by CMS, called the Quality Payment Program.

March 20, 2017 |

The House Rules Committee cleared for a House vote on Tuesday legislation promoting association health plans and repealing the anti-trust exemption for the health insurance industry.

December 20, 2016 | Daily News

CMS published Tuesday (Dec. 20) regulations on mandatory bundled pay demonstrations for cardiac and joint-replacement services, even though the incoming Republican administration opposes requiring providers to participate in demonstrations that test changes to Medicare reimbursement, and the agency finished writing policy for the accountable care organization Track 1 +, which aims to get more physicians to accept the risk of penalties for poor performance.

December 16, 2016 | Daily News

CMS announced Thursday (Dec. 15) a demonstration that pays bonuses to accountable care organizations for reducing Medicaid spending on beneficiaries enrolled in both Medicare and Medicaid, often referred to as dual eligibles, and the federal government for the first time is letting states share in Medicare savings.

November 11, 2016 | Daily News

Republicans will likely spare accountable care organizations and other demonstrations that the Affordable Care Act created, health care lobbyists and analysts say, and the CMS innovation center that runs the demos is expected to survive as well, although possibly under a different name and with restrictions such as prohibiting mandatory demos and requiring provider involvement in demo designs.

October 27, 2016 | Daily News

The Senate Finance Committee released wide-ranging, bipartisan draft chronic care legislation Thursday (Oct. 27) that among other reforms would extend by two years the Independence at Home demonstration, let kidney-failure patients enroll in Medicare Advantage, ease telehealth restrictions, and change how beneficiaries could be assigned to accountable care organizations.

October 26, 2016 | Daily News

CMS will unveil additional state Medicaid delivery and payment reforms before the Obama administration leaves office, and some of those reforms will help doctors receive Medicare bonuses in two years, CMS Deputy Administrator and Medicaid Director Victoria Wachino said Wednesday (Oct. 29).

October 25, 2016 | Daily News

CMS expects to give doctors more opportunities to qualify for alternative pay model bonuses in the new physician pay system by re-opening applications for 2018 participation in the Comprehensive Primary Care Plus and the Next Generation accountable care organization demonstrations and by starting two-sided risk in the Oncology Care Model in 2017, earlier than planned.

October 18, 2016 | Daily News

CMS says it's unclear what effect the recently announced pilot to reduce contractor audits of doctors participating in pay models with two-sided risk will have on Medicare's improper payment rate, though the agency has also said it believes the pilot will continue to protect Medicare program integrity.

October 17, 2016 | Daily News

CMS reduced the number of electronic health record requirements and shortened the reporting period to 90 days in the physician-pay system regulation published Friday (Oct. 14).

October 14, 2016 | Daily News

CMS says doctors participating in pay models that include penalties will be low priorities for reviews by Recovery Auditors and other contractors in a pilot scheduled to start in January.

October 06, 2016 | Daily News

As providers lose hope for an administrative solution, CAPG is asking for legislation that lets CMS count Medicare Advantage pay toward the revenue thresholds that determine whether providers qualify as participating in alternative pay models under the physician-pay system that CMS is developing.