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Spotlight on ACOs

November 13, 2013 | Daily News

The National Nursing Centers Consortium is urging CMS to replace its term “primary care physician” with “primary care clinician” in little-noticed guidelines sent recently to Arkansas on its patient centered medical home plan.

November 08, 2013 | Daily News

Congressional Medicare payment advisers are considering recommending changes for the second round of the Medicare ACO program, but first hope to determine whether accountable care organizations should remain a niche or whether the program should be spread widely.

October 07, 2013 | Daily News

Hospitals -- feeling pressure from tightening payments from government and private payers, and from HHS to beef up systems that base care on quality and volume -- are eagerly turning to insurance-like business models.

September 12, 2013 | Daily News

Congressional Medicare advisers on Thursday (Sept. 12) discussed the prospect of offering ACO beneficiaries Medigap plans with low premiums and reduced cost sharing when they visit in-network providers.

August 30, 2013 | Daily News

CMS is not interested in partnering with states on Medicaid shared savings programs based on cost savings alone, saying the programs must improve quality and health outcomes, according to agency guidance released Friday (Aug. 30) laying out what states need to consider when designing and implementing such initiatives.

August 15, 2013 | Daily News

A little-noticed Arkansas initiative to require most insurers, including those working with exchanges, to participate in a state-wide episode-based pay initiative is viewed as a possible game changer.

July 31, 2013 | Daily News

An elder care center is applying to CMS to test an ACO-like organization that would care for the frail elderly, which some seniors advocates believe could be a model for overhauling the long-term care system to handle the coming wave of dependent elderly.

July 16, 2013 | Daily News

Nine of the 32 pioneer accountable care organizations are dropping out of the program because they didn't produce savings in the first year, and seven of those nine are applying to participate in the separate Medicare Shared Savings Program initiative that lets ACOs operate longer before penalizing them for not reducing spending, CMS revealed Tuesday (July 16).

July 15, 2013 | Daily News

CMS is expected to announce on Tuesday (July 16) the performance results for the first year of the pioneer ACO demonstration and the number of accountable care organizations dropping out of the demo, physician lobbyists say.

June 28, 2013 | Daily News

Just fewer than 10 of the 32 pioneer ACOs either are dropping out of the demo or are considering doing so, and the four or five that are dropping out of the program are moving to a separate accountable care organization program, called the Medicare Shared Savings Program (MSSP), which does not punish ACOs for failing to meet cost and performance goals, a CMS source tells Inside Health Policy.

June 20, 2013 | Daily News

Sen. Ron Wyden (D-OR) said he hopes Congress will repeal a regulation that requires accountable care organizations accept all patients, which is a rule House Democrats insisted on to keep ACOs from cherry picking healthier beneficiaries and avoid making beneficiaries feel that ACOs limit their choice of providers.

June 03, 2013 | Daily News

CMS again is extending the deadline for Pioneer ACOs to decide whether they will stay in the high-profile health reform demonstration and is verifying with accountable care organizations the first-year performance results from the demo, on which pay will be partially based, an agency spokesperson said.

May 31, 2013 | Daily News

Rick Gilfillan, director of the CMS Innovation Center, will leave the agency at the end of June and will be temporarily replaced by Patrick Conway, according to an internal e-mail from CMS Administrator Marilyn Tavenner obtained by Inside Health Policy.

May 28, 2013 | Daily News

CMS recently told stakeholders that specialist practices would be locked into a single ACO if they bill for a lot of primary care, but an ACO consultant said specialist practices that participate in multiple ACOs and won't know until a year later if CMS views them as primary care providers.

May 20, 2013 | Daily News

The Congressional Budget Office expects a lot more seniors to enroll in Medicare Advantage plans than it did just a year ago, and health care consultancy firm Marwood Group said CBO's projections are conservative.

May 20, 2013 | Daily News

A bipartisan group of lawmakers from Pennsylvania has asked CMS to extend the Medicare Coordinated Care Demonstration, which is slated to terminated June 30, because they say it saves money and improves care, if only for the riskiest patients at a single demo location.

May 16, 2013 | Daily News

Pioneer ACOs looking to direct patients to lower-cost post-acute care settings recently received a primer on a study funded by the home-health industry that shows patients often could be discharged to lower-cost settings, according to Allen Dobson, president of the health economics firm Dobson | DaVanzo & Associates, which conducted the research.

May 15, 2013 | Daily News

CMS' Innovation Center is planning a second round of health care innovation grants that will divvy up $1 billion for creative projects focused on four specific payment and delivery reform models that fill in what CMMI Director Richard Gilfillan said Wednesday (May 15) were identified as gaps after the first round.

May 13, 2013 | Daily News

A top policy official at DaVita, who was “bummed” in February about CMS' terms for participation in the kidney care ACO demonstration, told investors the dialysis chain is now optimistic the agency will change the demo enough for the company to participate, although company officials say CMS has not indicated it will make the changes sought by DaVita.

May 06, 2013 | Daily News

CMS is lowering the minimum number of beneficiaries required for organizations to participate in Medicare's kidney-care ACO demonstration, now requiring that organizations have 350 matched beneficiaries to participate as opposed to 500.