Last Wednesday, September 18, 2013, Walgreen Company (“Walgreen”) announced its plan to move approximately 160,000 employees to Aon Hewitt’s private health exchange (the “Aon Exchange”) in 2014. This move marks a significant decrease in risk for Walgreen as the company will shift to a defined contribution model for funding its employees’ health insurance. Under the … Continue Reading
Squire Sanders attorneys, Chris Gordon, a Principal in the Washington, D.C. office, and Rob Nauman, a Senior Associate in the Columbus, Ohio office, were recently interviewed by Modern Healthcare for their take on the relaxation of the interim final rule on waivers of fraud and abuse laws and the antitrust policy statement on ACOs. Their … Continue Reading
Today at 2:00 P.M. (EDT), please join Squire Sanders and Strategic Health Care for our complimentary webinar overview of the final rule recently released by the Centers for Medicare & Medicaid Services (CMS) and the opportunities it presents for Accountable Care Organizations (ACOs). Speakers will include our own John Kirsner and Peter Pavarini as well as … Continue Reading
This post has been contributed by Chase Matson, Manager, Government Relations, AMDR When we published last week’s blog post, Medicare ACO Rules Near Final Hurdle, we knew it would only be a matter of time before CMS released its final ACO regulations. Sure enough, only two days later, CMS officially published their long-anticipated rules, ending … Continue Reading
On October 20, 2011, the Department of Justice and Federal Trade Commission jointly issued their “Final Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medical Shared Savings Program.” The policy statement, which largely mirrors the agencies’ proposed policy statement issued on April 19, 2011, outlines how the agencies will enforce U.S. … Continue Reading
Concurrently with the release of the final rule for accountable care organizations participating in the Medicare Shared Savings Program (“MSSP”), the Centers for Medicare and Medicaid Services (“CMS”) and the Department of Health and Human Services, Office of Inspector General (“OIG”) released an interim final rule with a comment period addressing waivers of certain fraud … Continue Reading
On October 20, 2011, the Centers for Medicare and Medicaid Services (“CMS”) released the nearly 700-page, final rule for payments to health care providers and suppliers participating in accountable care organizations (“ACOs”) under the Medicare Shared Savings Program (“MSSP”). In response to approximately 1,320 public comments to the proposed rule, the final rule makes a number … 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
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
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
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
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
