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Spotlight on ACOs

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.

March 09, 2016 | Daily News

House lawmakers, including Ways & Means and Energy & Commerce leaders from both parties, as well as Republicans senators raised concerns with CMS' plans to further rely on encounter data in risk adjustment, make other risk adjustment changes and cut payments to Employer Group Waiver Plans, though the House committee leaders like the agency's plan to better target resources for beneficiaries eligible for Medicare and Medicaid.

March 09, 2016 | Daily News

A bipartisan group of House committee leaders believes CMS in the draft 2017 Medicare Advantage and Part D Call letter implicitly recognizes that MA plans could qualify as alternative payment models under a new physician system, though one analyst said CMS has a long way to go before counting Medicare Advantage as an alternative pay model.

March 03, 2016 | Daily News

CMS reached its goal of tying 30 percent of traditional Medicare payments to alternative payment models 11 months ahead of schedule, and some lobbyists say the agency is set to increase the number of Medicare payments tied to value-based pay with the mandatory joint replacement bundle going into effect soon and providers looking to prepare for the new physician payment system.

February 25, 2016 | Daily News

Physician lobbyists plan to pressure CMS to loosen its interpretation of alternative payment models by making their case to the panel that advises the agency on those pay models, and the American Medical Association might seek outside legal help to fight CMS’ stance on what constitutes sufficient financial risk, an AMA executive said Wednesday (Feb. 24).

February 16, 2016 | Daily News

CMS plans to formally request advice on the design of hospital global pay models, said CMS Deputy Administrator and Chief Medical Officer Patrick Conway, who believes global payment models are promising for rural providers.

February 04, 2016 | Daily News

CMS officials indicated this week that they don’t plan to count bonus-only accountable care organizations as alternative pay models in the upcoming physician pay system.

January 29, 2016 | Daily News

The Next Generation Accountable Care Organization Model includes a telehealth waiver that is CMS' attempt to address telehealth inadequacies in Medicare by casting aside two major restrictive provisions, and telehealth advocates think the Centers for Medicare and Medicaid Innovation's new ACO pilot is a good step for telehealth.

January 28, 2016 | Daily News

CMS on Thursday (Jan. 28) proposed changes to ACO performance measures that the agency says would increase bonuses to accountable care organizations by calculating benchmarks based on local health care spending and by limiting the extent to which ACOs must compete against their own past performance.

January 26, 2016 | Daily News

President Obama’s Affordable Care Act is bolstering the Medicare Advantage program that Republicans created, according to an Avalere Health report funded by Aetna.