CMS releases ACO final rule, others agencies weigh-in

Posted on October 20, 2011 | No Comments
Filed under Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Department of Justice, Health Care Quality and Delivery System Reform, Health Insurance, Key Developments, Medicare, Office of Inspector General, Rulemaking, Rules, and Guidance

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The Centers for Medicare and Medicaid Services (CMS) released the much anticipated Accountable Care Organization (ACO) final rule, implementing section 3022 of the Affordable Care Act (ACA), which contains provisions relating to Medicare payments to providers of services and suppliers participating in ACOs under the Medicare Shared Savings Program. The rule on Medicare ACOs relaxes eligibility requirements for doctors and hospitals to participate by halving the number of performance measurements (65 to 33), removing the electronic medical records (EMR) requirement, and eliminating some financial risks. CMS also extended the deadline for ACO applications through 2012. As enticement to rural doctors and physician-owned practices, CMS said it would dedicate $170 million to said providers to start ACOs. Regulators estimate that between 50 and 270 ACOs will be established in the next 3 years, which will affect the care of 4% of Medicare beneficiaries.

Multiple federal agencies also released rules and guidance on fraud & abuse and antitrust issues related to ACOs. The HHS Office of Inspector General (OIG) issued an interim final rule (IFR) on the waiver of certain fraud and abuse provisions and the Department of Justice (DOJ) issued a statement on health care antitrust enforcement policies.

To read more about ACOs, click here.

For the ACO final rule fact sheet, click here.

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HHS announces 32 health care organizations to participate in Pioneer ACO Model

December 19, 2011

Today, the U.S. Department of Health and Human Service (HHS) named 32 health care organizations that will participate in the Pioneer Accountable Care Organization Model. The goal of the new ACO Model is to encourage providers, hospitals, specialists, and caregivers to provide more coordinated care, which could save $1.1 billion over a five year period, HHS projects. The Centers for Medicare & Medicaid Services (CMS) Innovation Center is spearheading this initiative and will reward groups that have formed ACOs based on improvements in health of their Medicare patients and their ability to lower health care costs. Under the Pioneer ACO Model, the 32 selected health care organizations will test the effectiveness of several innovative payment models. The goal of the Pioneer ACO model is to provide better care for beneficiaries, improved coordination with private payers, a reduction Medicare cost growth, and rewards for health care providers that deliver high-quality care. The 32 selected Pioneer ACOs represent urban and rural organizations from various geographic regions of the country, covering 18 states and 860,000 Medicare beneficiaries.

CMS announces new deadlines for Advance Payment Model

November 30, 2011

The Advance Payment Accountable Care Organization (ACO) Model is an initiative developed by the Centers for Medicare and Medicaid (CMS) Innovation Center designed for organizations participating as ACOs in the Medicare Shared Savings Program (Shared Savings Program). Through the Advance Payment Model, selected participants in the Shared Savings Program will receive advance payments that will be recouped from the shared savings they earn. CMS released a notice today announcing the new application deadline for participation in the Advance Payment Model for certain ACOs. Applications for the performance period beginning on April 1, 2012 will be accepted from January 3, 2012 through February 1, 2012. The period during which applications will be accepted for the performance period beginning on July 1, 2012 will remain identical to the period for the Medicare Shared Savings Program.

New Pioneer ACO Model Announced by CMS

May 20, 2011

The Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) have announced that the Center for Medicare and Medicaid Innovation (Innovation Center) will support a new type of Accountable Care Organization, called the Pioneer ACO Model. This type of ACO is designed to work in conjunction with both public and private payers and is estimated by the Medicare Chief Actuary to save up to $430 million over 3 years because of better care management and coordination. “The Pioneer Model is an opportunity for those organizations that have already adopted significant care coordination processes to move further and faster into seamless, coordinated care by utilizing alternative payment mechanisms,” said Richard Gilfillan, M.D., director of the Innovation Center. CMS will accept applications for Pioneer ACOs through July 18, 2011.

FTC to host information gathering workshop on ACO antitrust issues

May 3, 2011

The Federal Trade Commission (FTC) will host a workshop on May 9 to gather information on enforcing U.S. antitrust laws as they relate to the formation of Accountable Care Organizations (ACOs). The Department of Justice (DOJ) and the FTC issued a joint policy statement on ACO antitrust enforcement March 31, for which the comment period expires at the end of May.

Update: Medicare Shared Savings Program for Accountable Care Organizations

November 8, 2011

While a primary aim of the Affordable Care Act (ACA) was to increase access to affordable health insurance coverage, a critical, although less publicized, component of the law is a series of provisions designed to improve health care quality and efficiency and to advance the concept of “value-based purchasing.” The Agency for Health Care Research and Quality (AHRQ) defines the concept of value-based purchasing as holding “providers of health care accountable for both the cost and quality of care.” AHRQ notes that “value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. This strategy can be contrasted with more limited efforts to negotiate price discounts, which reduce costs but do little to ensure that quality of care is improved.”

Medicare Accountable Care Organizations

April 20, 2011

An earlier Implementation Brief provided an overview of the Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs), which was established by §3022 of the Affordable Care Act (ACA) by adding §1899 to the Social Security Act. On April 7, 2011, the federal Centers for Medicare and Medicaid Services (CMS) published a proposed rule implementing the MSSP. This proposed rule was accompanied by several additional policy documents:

Urban Institute paper reviews status of ACO implementation

November 1, 2011

"Accountable Care Organizations in Medicare and the Private Sector," a policy paper written by the Urban Institute and funded by the Robert Wood Johnson Foundation, examines the latest developments in accountable care organizations (ACOs), including a look at the final regulations issued last month by the Centers for Medicare & Medicaid Services (CMS). The paper provides an overview of ACOs, the key complaints about CMS' proposed regulations and their resolutions in the final regulations, and the status of adoption of this new model for delivering health care by both Medicare and private health insurance plans.

Commonwealth Fund releases paper reporting on ACO risk-sharing payment model

July 30, 2011

The Commonwealth Fund's paper, "Promising Payment Reform: Risk-Sharing With Accountable Care Organizations," describes and reports on the implementation of eight private accountable care organizations (ACOs) that use, or are planning to deploy, a shared payer–provider risk payment model. The Medicare Shared Savings Program, a component of the Affordable Care Act (ACA), creates financial incentives for ACOs to provide coordinated, well-integrated, efficient care. As ACOs continue to form, payers are establishing shared-savings programs and payment methods that confer a portion of the financial risk to the provider. There is minimal evidence, however, about what sort of payment model, shared-risk or otherwise, will most appropriately support ACOs. This report summarizes research on those ACOs that include a provider risk-sharing component.

New analysis examines ACOs and medically underserved populations

April 21, 2011

A recent analysis, funded by the RCHN Community Health Foundation and authored by researchers from the Geiger Gibson Program in Community Health Policy at the George Washington University, examines Medicare Accountable Care Organizations (ACOs) and their effect on community health center patients. The analysis finds that rules requiring ACO services to be provided by a physician only, may effectively exclude from ACO participation certain underserved populations who use non-physician providers for their primary care. Sara Rosenbaum, lead author of the study, is a frequent contributor to HealthReformGPS.

Commonwealth report provides recommendations for ACO implementation

April 14, 2011

A key provision of the Affordable Care Act (ACA) is the establishment of the Medicare Shared Savings Program, which provides incentives for improved quality and efficiency in a new category of provider--the accountable care organization (ACO). The ACO program is slated to begin in January 2012 and will reward groups of providers who agree to collaborate and offer more accountable, effective, and efficient care with a share of the savings that they achieve. The Commonwealth Fund Commission on a High Performance Health System's report "High Performance Accountable Care: Building on Success and Learning from Experience," provides recommendations for ensuring effective, efficient implementation and growth of the ACOs. Specifically, this report 1) sets forth the rationale for creating ACOs; 2) describes several promising types of ACO models that should be considered and evaluated as part of an effort to facilitate adaptability and spread of accountability for quality and cost; and 3) concludes with a set of Commission recommendations on what ought to be expected from ACOs and how to ensure their successful implementation and spread.