ACOs who apply for this first wave of the Medicare Shared Savings Program will be shouldering significant risk, especially given the unknowns left after the Proposed Rules were released. Few organizations will be in a position by January 2012 to even apply for participation in the shared savings program, in all probability. Those ACOs that … Continue Reading
Join Squire Sanders and Strategic Health Care this Friday, April 8 at 11 a.m. EDT for a national webinar, “ACO Regulation Review and Application Preparation.” Squire Sanders partners Peter A. Pavarini and John M. Kirsner will discuss legal considerations relevant to the proposed Accountable Care Organization (ACO) regulations issued by the Centers for Medicare & Medicaid Services … Continue Reading
I agree with my colleagues that CMS appears to be looking to the industry to guide them on waiver development, as well as other details of the Medicare Shared Savings Program. CMS intends to grant waivers that would apply uniformly to all ACOs, ACO participants and ACO providers/suppliers participating in the Medicare Shared Savings Program. … Continue Reading
The 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
Does anyone else feel that the proposed waiver regulations don’t go far enough? Do you think they allow providers to engage in flexible arrangements that deliver value to the government? The key is how the government has limited the waiver proposals mostly only to the shared savings distributions. That seems too narrow, although I think … Continue Reading
The Federal Trade Commission and Department of Justice (the “Agencies”) recently released Proposed Statement of Antitrust Enforcement Policy Regarding ACOs, which contains several points of interest: Rule of Reason Treatment. The Agencies will provide rule of reason treatment to an ACO if, in the commercial market, the ACO uses the same governance and leadership structure and … Continue Reading
By Daniel J. Vukelich, President, Association of Medical Device Reprocessors I’ve been thinking about Robert Pear’s analogy, as he wrote in today’s New York Times that: Until now, accountable care organizations were like unicorns, creatures that flourished in the imagination but proved persistently elusive in the natural world. The rules define the new entity as a … Continue Reading
The proposed CMS rules for accountable care organizations have only been out a few hours and even the speediest readers are still plowing through them, but a few initial observations are in order: CMS is admitting it needs more than the usual amount of public comment to craft final rules. Perhaps this was intentional but … Continue Reading
Several important antitrust points of interest in the hot-off-the-presses ACO regulations issued today: The Department of Justice and the Federal Trade Commission have a new challenge – figuring rules of the road as joint administrators of the ACO antitrust review process, acting through a newly formed joint working committee. The agencies will either have to … Continue Reading
Staying on top of rapid change in the medical industry is a major challenge for our clients, and the American Health Lawyers Association does an incredible job of tracking trends so we can keep our clients up to speed. I’m honored to have been asked to present at its conference, “Institute on Medicare and Medicaid … Continue Reading
On March 15, Ohio Governor John Kasich announced his proposal to balance Ohio’s budget (the Blue Book). Because the Ohio budget is in large part reserved for Medicaid, health care changes play a significant role in the new budget plan. Governor Kasich’s budget proposal included establishing pediatric accountable care organizations (Pediatric ACOs). The following discussion outlines the … Continue Reading
With the issuance of proposed rules for accountable care organizations (ACOs) just days away (CMS Deputy Director Marilyn Tavenner has been quoted as saying they’ll be out by April 1, 2011), many in the healthcare industry are beginning to wonder how ACOs will pay for themselves. Drs. Trent Haywood and Keith Kosel have predicted that … Continue Reading
At the 2011 University of Miami Global Business Forum, a panel was convened to discuss accountable care organizations (ACOs). This panel broke new ground in answering how health care reform and market forces will create patient-centered care and ACOs. ACO is defined by the Centers for Medicare and Medicaid Services (CMS), as “an organization of health care providers … Continue Reading
