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Spotlight on ACOs

July 28, 2016 | Daily News

CMS' proposal to count bundled pay models as alternative pay models would help specialists earn more money under the Medicare pay system the agency is developing, but hospitals are wary of the mandatory pay bundle.

July 26, 2016 | Daily News

Although CMS wants to push more providers into risk-bearing accountable care organizations, Brookings Institution scholars and many providers say the agency could inadvertently do the opposite by making it possible for providers in ACOs that don't accept the risk of penalties to get much larger bonuses than providers in risk-bearing ACOs.

July 25, 2016 | Daily News

CMS on Monday (July 25) proposed another mandatory pay bundle, this one for cardiac care, along with a cardiac rehabilitation incentive-pay program and the addition of hip and femur fractures to the hip and knee replacement pay bundle.

July 20, 2016 | Daily News

The IRS denied a commercial accountable care organization tax-exempt status earlier this year -- though ACOs participating in the Medicare Shared Savings Program are eligible for tax-exempt charitable status -- and some say the decision raises questions about how different types of ACOs are treated as far as their tax status.

July 08, 2016 | Daily News

The House Energy & Commerce health subcommittee mulled over the Advancing Care for Exceptional Kids Act's medical home model with an enhanced federal match for medically complex children.

July 05, 2016 | Daily News

A bipartisan group of 70 House lawmakers is pressing CMS to waive, to the extent possible, certain restrictions on hospitals and post-acute care providers when they participate in alternative pay models that accept the risk of penalties.

June 13, 2016 | Daily News

CMS will let providers in the accountable care organization program participate in the Comprehensive Primary Care Plus demonstration, but CPC+ participation will not earn track one ACOs the 5 percent bonus in the new physician pay system that CMS is developing, according to a recently updated agency document on the CPC+ program.

June 13, 2016 | Daily News

CMS’ recent policy reversal that lets accountable care organizations participate in the Comprehensive Primary Care Plus (CPC+) demonstration bolsters the case for letting ACOs participate in other pay-for-performance demonstrations, including the Comprehensive Care for Joint Replacement demo and the Bundled Payments for Care Improvement initiative, a provider consultant says.

June 06, 2016 | Daily News

CMS will slow the incorporation of regional spending into accountable care organization benchmarks, thereby lessening the financial hit to ACOs with spending that is higher than average in their regions, according to a regulation CMS published Monday (June 6) on the Medicare Shared Savings Program.

May 24, 2016 | Daily News

Mental health advocates say CMS hasn't adequately factored behavioral health into its aggressive efforts to create Center for Medicare and Medicaid Innovation demonstrations that test new value-based payment models.

May 23, 2016 | Daily News

Although the Comprehensive Care for Joint Replacement demonstration currently does not qualify as an alternative pay model, the proposed rule on the new physician pay system indicates CMS staff would like to make adjustments to let the demonstration count.

May 20, 2016 | Daily News

CMS Deputy Administrator for Innovation and Quality Patrick Conway said the agency is considering how certain Center for Medicare and Medicaid Innovation models and demonstrations might work together.

May 04, 2016 | Daily News

Primary providers are upset that CMS proposes to exclude medical homes that don't accept the risk of penalties from the definition of alternative pay model.

April 27, 2016 | Daily News

The long-awaited proposal to revamp Medicare's physician-pay system doesn’t count arrangements in Medicare Advantage toward the payment calculation in the Alternative Payment Model Incentive Payments program, but CMS proposes to use MA arrangements, as well as pay arrangements from private and Medicaid plans, to determine whether providers qualify as alternative payment models under the pay scheme.

April 11, 2016 | Daily News

CMS is building off the Comprehensive Primary Care Initiative with a new multi-payer primary-care payment model that is set to be the agency's largest plan ever to change how primary care is delivered, the agency announced Monday (April 11).

April 04, 2016 | Daily News

Accountable care organizations allege CMS officials are being “duplicitous” by ostensibly accepting providers' advice to limit the extent to which ACOs must compete against their own past performance while at the same time designing the policy change to reduce Medicare spending, instead of making it budget neutral.

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.