We’re getting some good traction in the hospital and physician trade press regarding our analysis of the ACO regs. I provided an interview with Physicians Practice (provided with permission of the publisher) discussing the shared savings models of the proposed rules for accountable care organizations and balancing risk versus reward in establishing new health care partnerships. The… Continue Reading
Category Archives: Payment Methodologies
Subscribe to Payment Methodologies RSS FeedACOs: Will High Start up Costs and Downside Risk Limit Interest in This Health Care Reform Darling?
Posted in Accountable Care Organizations, Payment MethodologiesProviders considering applying to CMS to become an ACO should be aware that the proposed ACO rules are modeled in significant part after Medicare’s Physician Group Practice demonstration project. Five years in the planning and launched in April 2005, the PGP Demonstration included 10 multi-specialty group practices in various regions of the country comprised of… Continue Reading
Prospective or Retrospective Beneficiary Assignments to Calculate Eligibility for Shared Savings
Posted in Accountable Care Organizations, Payment MethodologiesCMS has considered two basic options for assigning beneficiaries to an ACO to calculate eligibility for shared savings. The first option is that beneficiary assignment would occur at the beginning of the performance year on a prospective basis. The second option is for beneficiary assignment to occur on a retrospective basis based on the actual… Continue Reading
Introducing Risk Through a Shared Savings Program: The Two-Sided Model – A Carrot and Stick Approach
Posted in Accountable Care Organizations, Payment MethodologiesThe Accountable Care Act permits the Secretary of HHS to implement partial capitation models or any other payment model the Secretary determines will improve quality and efficiency. The Proposed Rule states that the Secretary will test partial capitation models in the Innovation Center. Pursuant to the “other payment model” authority, however, the Proposed Rule would… Continue Reading