Accountable Care Organizations

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When Forming ACOs, Plan For Disputes And Terminations

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

Are Racial/Ethnic Disparities Being Forgotten Among All of the Other Concerns in ACO Development?

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

Looking Behind the Curtain at Structures and Capabilities of ACOs

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

LiveBlog of FTC Workshop: Another Dose of Competition, Accountable Care Organizations and Antitrust

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

How do we develop ACOs that are designed to bring hospitals and physicians closer together while at the same time abide by laws designed to separate them?

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

SSD Health Practice Lawyer Offers Guidance to Hospital CEOs in Fierce Healthcare's Hospital Insider

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

Upcoming CMS and FTC Public Forums Provide Opportunity to Comment on ACO Related Regulations

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

Physicians Practice Interview on ACO Payments: Risk, Reward, and Reviewing Your Healthcare Partners

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

ACOs: Will High Start up Costs and Downside Risk Limit Interest in This Health Care Reform Darling?

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

Majority vs. Plurality Rule for Beneficiary Assignment

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

Discord at the Agencies Regarding Antitrust Reviews?

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

Proposed Definition of At-Risk ACO Beneficiaries Leaves Questions Unanswered

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

Prospective or Retrospective Beneficiary Assignments to Calculate Eligibility for Shared Savings

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

The ACO Information Gold Rush: "Accountable Care Organizations" in the News

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

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

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

Squire Sanders Participates in Successful Webinar on ACOs with Strategic Health Care and Plante Moran

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

Taking the Antitrust Policy Statement a Step Further…

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

Two views on Beneficiary Data Implications for Patients and ACOs: Part 2 – ACOs Use of Medicare Beneficiary Identifiable Claims Data to Track Population Health and Expenditures

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

Two Views on Beneficiary Data Implications for Patients and ACOs: Part 1 – Balancing Patient Privacy With the Objectives of the Program

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

Why AMDR and ACOs?

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

Something Old, Something New, Something Borrowed….

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
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