Last Thursday, CMS announced four free “accelerated development sessions” (ADSs). CMS describes the ADSs as “providing executives with the opportunity to learn about core functions of an Accountable Care Organization (ACO) and ways to build their organization’s capacity to succeed as an ACO. This 3-day, in-person ADS is to help new ACOs deliver better care … Continue Reading
By Sharon Bee Cheng, Strategic Healthcare Cash bonuses for ACOs will be funded by the savings they generate for the Medicare program. However, ACOs will not receive the entire portion of savings they are entitled to unless their performance on quality measures is among the best in the country. Each ACO will be measured on … Continue Reading
Many attorneys, commentators and consultants are recommending swift action for providers interested in participating in the Shared Savings Program through an Accountable Care Organization (“ACO”) because of the following: Primary care providers must be exclusive to one ACO; Applications for the first Shared Savings Program year, which starts on January 1, 2012, will likely be … Continue Reading
Following the release of the ACO regulations by CMS and the concurrent release of guidance documents from the IRS, FTC, DOJ and OIG, much of the attention of the health care industry has been focused on the practical implementation of ACOs, tax considerations, fraud and abuse concerns, improved quality of care, and the potential for … Continue Reading
Our very own Peter Pavarini is published this week in BNA’s Healthcare Policy Report. Do you have thoughts or questions about Peter’s article? Write us and we’ll have him answer. Congratulations Peter.… Continue Reading
By Sharon Bee Cheng, Strategic Healthcare I’m honored to be asked by the team at to offer some of our firm’s insight into what CMS is seeking in its regulations governing ACOs. CMS hopes that the formation of ACOs will prompt some reorganization of health systems, even the most integrated ones. Organizations that already substantially … Continue Reading
1:15PM—The workshop concluded a few minutes ago. Overall, I suspect that most people present or who listened or viewed the webcast would agree that the discussion was helpful and certainly many excellent points were brought forward to the regulators. Particularly in the second session, the regulators asked many probing questions, a good sign of their … Continue Reading
Yesterday, the Centers for Medicare & Medicaid Services (CMS) presented an hour-long webinar on ACOs and Antitrust, Stark Law, Anti-Kickback Statute (AKS) and Civil Monetary Penalty Law (CMP), hosted by Troy Barsky, Director, Division of Technical Payment Policy and Michael Wroblewski, Performance-Based Policy Payment Staff for CMS. Troy Barsky addressed Stark, AKS and CMP laws. … Continue Reading
A tip of the hat to David Kopans, www.accountablecareforum blogger and Squire Sanders lawyer, for his post on Fierce Healthcare’s Hospital Insider titled:”Eight Things Hospital CEOs Should Know about The ACO Regulations.” David’s analysis has the #ACO Twitter community abuzz; and it’s great our bloggers are being recognized for analysis on ACO regulation impact on … Continue Reading
CMS is on the clock first, with a free webinar titled, “ACOs and Antitrust, Stark, Anti-Kickback, & Civil Monetary Penalty Law Webinar.” Hosted by Troy Barsky, Director, Division of Technical Payment Policy at CMS and Michael Wroblewski, Performance-based Policy Payment Staff, the event is broken into two sessions this Thursday, May 5th, the first beginning … Continue Reading
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 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 interview centered on how the … Continue Reading
Providers 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
The Affordable Care Act requires the assignment of Medicare beneficiaries based on which physician provides a beneficiary’s primary care services, and delegates the task of prescribing the assignment methodology to the Secretary of Health and Human Services. After considering a majority rule and a plurality rule, CMS believes that the latter should be the governing … Continue Reading
As discussed previously here, here, and here, antitrust matters are a key consideration in the design of the Shared Savings Program and ACO development. For example, antitrust review of prospective ACOs by the FTC and/or DOJ is a critical aspect of the ACO application process. Despite the release of the joint statement, there is evidence … Continue Reading
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
CMS 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
by David Sheon, WHITECOAT Strategies What a week since CMS launched its regulations on ACOs. The complexity of the rules offered little help to journalists seeking to explain the implications to readers. CMS tried its best to help by providing fact sheets for providers as well as for consumers. And while most journalists writing on … Continue Reading
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
On Friday, April 8, Peter Pavarini and I co-presented a webinar overviewing the ACO regulations from a legal perspective. We were part of a three-firm “task force” that came together to analyze the rules and provide guidance to our clients and friends. In addition to Squire Sanders, Paul Lee and others from Strategic Health Care and … Continue Reading
In commentary to the proposed regulations, CMS has committed to coordinate with other Federal agencies on various issues that relate to the Shared Savings Program. This includes coordination with the FTC and DOJ (the “Antitrust Agencies”) with respect to antitrust issues. This coordination is shown through CMS’s intention to incorporate the FTC/DOJ Proposed Statement on … Continue Reading
Section 3022 of the Affordable Care Act (ACA) provides for the development of the Medicare shared savings program for accountable care organizations (ACOs). The ACO program is intended to improve care for individuals and health for populations, as well as slow the rate of cost growth. The proposed rule recently released by the Centers for … Continue Reading
Under the proposed ACO rules, CMS will assign Medicare beneficiaries to ACOs based on where the patient receives the “plurality” of their primary care services during the year before the relevant ACO performance measurement period. If medical cost savings can be achieved during the performance period for the ACO’s assigned beneficiaries as compared against the CMS projected benchmark … Continue Reading
By Daniel J. Vukelich, AMDR The acronyms and new terminology alone can be overwhelming: ACO: Accountable Care Organization; SSP: Shared Savings Program; VBP: Value-Based Purchasing; HIT: Health Information Technology; and of course, AMDR: Association of Medical Device Reprocessors. Medical Device Reprocessors? What do medical device reprocessors have to do with ACOs or even healthcare reform for … Continue Reading
For many of us still digesting last week’s ACO manifesto, the first question we must answer is what kind of organization should seek to qualify as an ACO? “In order to implement the statutory requirements that ACOs have a shared governance mechanism and a formal legal structure for receiving and distributing shared payments, we (CMS) … Continue Reading
