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Spotlight on ACOs

December 04, 2014 | Daily News

The American Hospital Association says HHS' Office of Inspector General needs to change its “misbegotten” stance on the gainsharing Civil Monetary Penalty (CMP) rule, which the hospital group says would prohibit hospitals from rewarding physicians “for following protocols that call for the delivery of medically necessary services.”

December 01, 2014 | Daily News

Provider lobbyists offered a mixed initial reaction to a CMS proposal, released Monday (Dec. 1), to give accountable care organizations another three years without the risk of penalties, albeit with smaller shared savings for good performance.

December 01, 2014 | Daily News

The White House Office of Management and Budget finished reviewing CMS' proposed rule for the second round of accountable care organization contracts, according to OMB's website, and a hospital official following the rule said it's likely that CMS will propose the rule this week.

October 16, 2014 | Daily News

CMS and the HHS Office of Inspector General on Thursday (Oct. 16) extended waivers they had earlier granted for Accountable Care Organizations to get around some fraud and abuse laws, saying a proposed rule for the second round of the health law's Shared Savings Program is still in the works and the agencies would benefit from ACOs' input on whether the waivers are useful in their current form or should be changed.

October 15, 2014 | Daily News

CMS has decided to loan money to ACOs in rural and underserved areas in response to complaints that some accountable care organizations can’t afford the information technology systems or the changes to their practices that are needed to perform well enough to receive bonuses.

The initiative, unveiled Wednesday (Oct. 15), makes $114 million available to as many as 75 ACOs. CMS will recover those payments by paying less in shared-savings bonuses to ACOs that take out the loans, an agency release states.

October 15, 2014 | Daily News

CMS has decided to loan money to ACOs in rural and underserved areas in response to complaints that some accountable care organizations can’t afford the information technology systems or the changes to their practices that are needed to perform well enough to receive bonuses.

The initiative, unveiled Wednesday (Oct. 15), makes $114 million available to as many as 75 ACOs. CMS will recover those payments by paying less in shared-savings bonuses to ACOs that take out the loans, an agency release states.

October 07, 2014 | Daily News

Avalere Health in a recent analysis found that 59 percent of the ACOs that earned bonuses in the first year of the program scored below average on the quality of care they provide, which means that those accountable care organizations would not have earned bonuses in the second year of the program when they are required to meet quality targets.

Many policymakers assume that delivering higher quality care helps lower spending, but Senior Vice President Erik Johnson said the results indicate that might not be true.

October 02, 2014 | Daily News

The National Governors Association is kicking off a year-long project in Alabama, Nevada and Washington state to study workforce transformation, multi-payer initiatives, and sharing savings efforts underway in those states' Medicaid programs for potential broader application. Carol Backstrom, program director for NGA's health division, said she hopes that CMS and the states will come to agreement on promising concepts for statewide Medicaid transformation, although she cautioned that NGA is in the early stages of the process.

September 30, 2014 | Daily News

CMS is considering letting accountable care organizations combine with drug plans and Medicaid and accept global payments, CMS innovation center head Patrick Conway said Tuesday (Sept. 30). The agency plans to soon request input from the public on plan designs for CMS to test, and that “request for information” will provide an opportunity for plans to suggest changes to ACOs.

September 26, 2014 | Daily News

Reps. Diane Black (R-TN) and Peter Welch (D-VT) are pushing legislation to test capitated Medicare ACOs in a demonstration that eventually could be ramped up nationally. The pay structure of the ACOs would resemble HMOs (health maintenance organizations), but patients would be allowed to visit providers out of network as they are in ACOs.

The idea of the bipartisan House bill, introduced last week, is to move ACOs away from fee-for-service by paying them a set amount for each enrolled person, which is referred to as capitation.

September 25, 2014 | Daily News

CMS has extended the Multi-Payer Advanced Primary Care Practice Demonstration for two more years following pressure from both states and some lawmakers, though the extension will not be available for all six of the eight states currently in the demonstration.

September 16, 2014 | Daily News

Of the 220 accountable care organizations in the Medicare Shared Savings Program, 53 ACOs earned bonuses and another 52 reduced Medicare costs but not by enough to share in savings, according to the first-year results released by CMS Tuesday (Sept. 16). Second-year financial performance of ACOs in the separate, much smaller pioneer demonstration was a little better than in the first year.

September 09, 2014 | Daily News

Accountable care organizations likely will not curb spending much at first, according to the CMS publication Medicare and Medicaid Research Review, but researchers identified promising policies for lowering costs in the long-term, including engaging patients, using telemedicine, improving care transitions and letting non-physician providers take over some of the work from physicians. The researchers studied the physician group practice demonstration on which the Accountable Care Act based accountable care organizations.

August 28, 2014 | Daily News

CMS does not plan to waive restrictions on telemedicine services for accountable care organizations in the Medicare Shared Savings Program, an agency spokesman says, but it would consider doing so for pioneer ACOs separately participating in a demonstration. Congress is interested in using telecommunication, such as video conferencing, to reduce Medicare spending by allowing doctors to see patients who have difficulty making doctor visits in person, and many providers believe ACOs and bundled pay arrangements are a way to extend telemedicine services without abusing them.

August 25, 2014 | Daily News

The White House Office of Management and Budget rejected CMS' proposed rule on the second round of accountable care organization contracts, provider lobbyists say, but it appears the agency will forge ahead with proposed updates to quality measures that take effect next year, even though other changes to the program will not be known until later.

June 26, 2014 | Daily News

The White House's Office of Management and Budget on Thursday (June 26) received CMS' proposed rule for the second round of the accountable care organization program, according to the OMB's website.

June 10, 2014 | Daily News

On Secretary Sylvia Burwell's first first day at HHS, a group of ACOs, patient advocates and telehealth interests urged her to lift restrictions on ACOs using telemedicine in the next round of contracts under the Medicare Shared Savings Program.

April 25, 2014 | Daily News

Two-thirds of accountable care organizations surveyed by the National Association of ACOs said they are unlikely to adopt a two-sided risk model in the next round of contracts, which an ACO consultant said is tantamount to threatening to drop out of the Medicare Shared Savings Program unless CMS takes away the threat of penalties in the second round of three-year contracts.

April 25, 2014 | Daily News

Kidney care stakeholders pushed CMS for more details surrounding changes to the kidney care ACO demonstration, peppering the agency Thursday (April 24) with questions about how smaller dialysis facilities will be able to band together when forming a kidney care ACO and its decision to remove the smaller facilities' opportunity to participate in a two-sided risk model.

April 24, 2014 | Daily News

Lobbyists expect CMS to propose major ACO policy changes this fall aimed at keeping accountable care organizations from dropping out during the second round of contracts in the program, which agency officials often tout as a key example of how the Affordable Care Act is reforming the health care system.

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