Spotlight on ACOs

Six Part D plans that provide benefits to about 1.6 million beneficiaries will participate in the enhanced Medication Therapy Management demonstration starting in January, CMS announced Monday (Oct. 3).

If providers submit at least some data, including information dating after Jan. 1 of next year, to the Quality Payment Program, they'll avoid pay cuts under the new pay system under development by CMS, Acting Commissioner Andy Slavitt announced in a blog post.

Medicare spent $217 million more in bonuses to accountable care organizations than the ACO program saved, according to CMS figures released Thursday (Aug. 25).

CMS proposes waiving some geographic telehealth restrictions in its cardiac care pay bundle, but a telehealth lobbyist said other restrictions would remain, which could discourage providers from using telehealth services.

CMS estimates that up to 5,000 primary care practices will participate in the agency's new Comprehensive Primary Care Plus model across 14 different areas of the country, but the agency on Monday (Aug. 1) projected far fewer patients would participate than earlier anticipated.

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.

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.

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.

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.