Spotlight on ACOs

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.

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.

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.

The CMS review of one of the first alternative pay models to be recommended by an independent outside organization is moving along swiftly, CMS Administrator Seema Verma said Thursday (March 22), and the agency plans to help doctors deal with restrictions against self-referrals that providers say impede alternative payment model development.

The National Association of Accountable Care Organizations is calling for patience after HHS Secretary Alex Azar said ACOs' performance has been underwhelming, with the group arguing an ACO's success should be defined by how the organization compares to other providers, not just to CMS benchmarks.

Thirteen more accountable care organizations are participating in the Next Generation ACO model this year compared to 2017, according to CMS data.

The White House Office of Management and Budget is reviewing an interim final rule on “Addressing Extreme and Uncontrollable Circumstances” for the Medicare Shared Savings program.

The Physician-Focused Payment Technical Advisory Committee chair and vice chair asked lawmakers on Wednesday (Nov. 8) to consider letting PTAC help doctors with technical aspects of alternative pay models, giving doctors in APMs more claims data and allow for limited small-scale testing of new models.

The White House Office of Management and Budget on Thursday (Nov. 2) began reviewing a final rule that would shrink the mandatory Comprehensive Care for Joint Replacement demonstration and cancel the Episode Payment Models and Cardiac Rehabilitation incentive models.