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Category Archives: Quality and Performance Measures

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Proposed Definition of At-Risk ACO Beneficiaries Leaves Questions Unanswered

Posted in Accountable Care Organizations, Quality and Performance Measures

Among other reasons, CMS may terminate an ACO from participating in the Medicare Shared Savings Program if the ACO avoids “patients at risk” to reduce the likelihood of increasing costs to the ACO.  The Affordable Care Act, however, does not define which patients are at risk. In the recently release proposed ACO rule, CMS proposes… Continue Reading

When it Comes to ACOs, Some Primary Care Physicians are More Equal Than Others

Posted in Accountable Care Organizations, Quality and Performance Measures

Although the Affordable Care Act allows hospitals employing physicians and other non-physician professionals such as advance practice nurses, physician assistants and nurse practitioners, to be eligible providers for an ACO, only primary care services provided by primary care physicians matter in determining the beneficiaries that would be assigned to an ACO. And only those ACOs… Continue Reading