CMS Issues Long-Awaited Proposal on ACOs

After months of deliberation, offi­cials at the Centers for Medicare and Medicaid Services released a proposed rule outlining how physicians, hospitals, and long-term care facilities can work together to form accountable care organizations and share in the sav­ings they achieve for Medicare.

The voluntary program was created under the Affordable Care Act and will begin in Jan. 2012. Under the proposal, accountable care organizations (ACOs) could include physicians in group prac­tice, networks of individual practices, hospitals that employ physicians, and partnerships among these entities, as well as other providers. The idea is for ACOs to be a partnership among a range of physicians, including specialists and primary care providers. However, only primary care providers will be able to form an ACO, according to CMS.

<[stk -1]>According to the proposed rule, providers in the ACO would continue to receive their regular fee-for-service pay­ments under Medicare, but they could also qualify for additional payment if their care resulted in savings to the pro­gram. The proposed framework requires that ACOs meet certain quality standards and demonstrate that they have reduced costs in order to be eligible to share in any savings. The proposal outlines 65 quality measures in five quality domains: patient experience, care coordination, patient safety, preventive health, and care of at-risk and frail elderly populations.For qc, not for linking. <http://www.healthcare.gov/news/factsheets/accountablecare03312011a.html > <[etk]>

“ACOs aren’t just a new way to pay for care; they’re a new model for the organization and delivery of the care under Medicare,” Dr. Donald Berwick, CMS administrator, said during a press con­ference to announce the proposed rule.

Dr. Berwick said he doesn’t know how many ACOs will form under the pro­gram, but that the level of interest is “enormous.”

Since the Affordable Care Act was passed last year, the health care com­
munity has been buzzing about how ACOs might be structured and if they could succeed in reducing health care costs. Integrated care organizations like Geisinger Health System in Danville, Pa., are considered to have a leg up because their hospital and outpatient care is already coordinated.

But Dr. Berwick said that the propos­al allows for ACOs at various levels of development to participate. For example, less developed ACOs can choose to re­ceive only shared savings for 2 years be­fore assuming risk. More mature organizations can assume risk immedi­ately but be eligible for greater levels of shared savings. “Our aim is to create on-ramps that will allow many to participate, depending on the different levels of maturity they are starting with,” Dr. Berwick said.

CMS officials estimate that the pro­gram could result in as much as $960 mil­lion in Medicare savings over 3 years.

<[stk -3]>Although federal officials said that they expect the coordinated care to pay divi­dends in savings to Medicare, ACOs will not be set up like HMOs. Medicare bene­ficiaries will still be able to see their choice of providers under fee-for-service Medicare. Providers will be the ones that enroll in ACOs and must notify patients they are receiving care within an ACO. <[etk]>

In addition to the ACO proposed rule, the Department of Justice and the Federal Trade Commission have also issued guidance on how physicians and hospi­tals that form an ACO can steer clear of antitrust laws. «http://www.ftc.gov/opp/aco» Officials at the CMS and the Office of the Inspector General have also issued a notice on potential waivers that could be granted in connection with the shared savings program, «http://www.ofr.gov/OFRUpload/OFRData/2011-07884_PI.pdf» and the In­ternal Revenue Service has issued new guidance for tax-exempt hospitals seek­ing to participate in the program.«http://www.irs.gov/pub/irs-drop/n-11-20.pdf»

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The CMS will be accepting comments on the proposed rule for 60 days<official publication date in the FR is April 7>. The agency also plans a series of open-door forums and listening sessions to explain the proposal and to get feedback from the public.

After months of deliberation, offi­cials at the Centers for Medicare and Medicaid Services released a proposed rule outlining how physicians, hospitals, and long-term care facilities can work together to form accountable care organizations and share in the sav­ings they achieve for Medicare.

The voluntary program was created under the Affordable Care Act and will begin in Jan. 2012. Under the proposal, accountable care organizations (ACOs) could include physicians in group prac­tice, networks of individual practices, hospitals that employ physicians, and partnerships among these entities, as well as other providers. The idea is for ACOs to be a partnership among a range of physicians, including specialists and primary care providers. However, only primary care providers will be able to form an ACO, according to CMS.

<[stk -1]>According to the proposed rule, providers in the ACO would continue to receive their regular fee-for-service pay­ments under Medicare, but they could also qualify for additional payment if their care resulted in savings to the pro­gram. The proposed framework requires that ACOs meet certain quality standards and demonstrate that they have reduced costs in order to be eligible to share in any savings. The proposal outlines 65 quality measures in five quality domains: patient experience, care coordination, patient safety, preventive health, and care of at-risk and frail elderly populations.For qc, not for linking. <http://www.healthcare.gov/news/factsheets/accountablecare03312011a.html > <[etk]>

“ACOs aren’t just a new way to pay for care; they’re a new model for the organization and delivery of the care under Medicare,” Dr. Donald Berwick, CMS administrator, said during a press con­ference to announce the proposed rule.

Dr. Berwick said he doesn’t know how many ACOs will form under the pro­gram, but that the level of interest is “enormous.”

Since the Affordable Care Act was passed last year, the health care com­
munity has been buzzing about how ACOs might be structured and if they could succeed in reducing health care costs. Integrated care organizations like Geisinger Health System in Danville, Pa., are considered to have a leg up because their hospital and outpatient care is already coordinated.

But Dr. Berwick said that the propos­al allows for ACOs at various levels of development to participate. For example, less developed ACOs can choose to re­ceive only shared savings for 2 years be­fore assuming risk. More mature organizations can assume risk immedi­ately but be eligible for greater levels of shared savings. “Our aim is to create on-ramps that will allow many to participate, depending on the different levels of maturity they are starting with,” Dr. Berwick said.

CMS officials estimate that the pro­gram could result in as much as $960 mil­lion in Medicare savings over 3 years.

<[stk -3]>Although federal officials said that they expect the coordinated care to pay divi­dends in savings to Medicare, ACOs will not be set up like HMOs. Medicare bene­ficiaries will still be able to see their choice of providers under fee-for-service Medicare. Providers will be the ones that enroll in ACOs and must notify patients they are receiving care within an ACO. <[etk]>

In addition to the ACO proposed rule, the Department of Justice and the Federal Trade Commission have also issued guidance on how physicians and hospi­tals that form an ACO can steer clear of antitrust laws. «http://www.ftc.gov/opp/aco» Officials at the CMS and the Office of the Inspector General have also issued a notice on potential waivers that could be granted in connection with the shared savings program, «http://www.ofr.gov/OFRUpload/OFRData/2011-07884_PI.pdf» and the In­ternal Revenue Service has issued new guidance for tax-exempt hospitals seek­ing to participate in the program.«http://www.irs.gov/pub/irs-drop/n-11-20.pdf»

I have checked the following facts in my story: (Please initial each.)

The CMS will be accepting comments on the proposed rule for 60 days<official publication date in the FR is April 7>. The agency also plans a series of open-door forums and listening sessions to explain the proposal and to get feedback from the public.

After months of deliberation, offi­cials at the Centers for Medicare and Medicaid Services released a proposed rule outlining how physicians, hospitals, and long-term care facilities can work together to form accountable care organizations and share in the sav­ings they achieve for Medicare.

The voluntary program was created under the Affordable Care Act and will begin in Jan. 2012. Under the proposal, accountable care organizations (ACOs) could include physicians in group prac­tice, networks of individual practices, hospitals that employ physicians, and partnerships among these entities, as well as other providers. The idea is for ACOs to be a partnership among a range of physicians, including specialists and primary care providers. However, only primary care providers will be able to form an ACO, according to CMS.

<[stk -1]>According to the proposed rule, providers in the ACO would continue to receive their regular fee-for-service pay­ments under Medicare, but they could also qualify for additional payment if their care resulted in savings to the pro­gram. The proposed framework requires that ACOs meet certain quality standards and demonstrate that they have reduced costs in order to be eligible to share in any savings. The proposal outlines 65 quality measures in five quality domains: patient experience, care coordination, patient safety, preventive health, and care of at-risk and frail elderly populations.For qc, not for linking. <http://www.healthcare.gov/news/factsheets/accountablecare03312011a.html > <[etk]>

“ACOs aren’t just a new way to pay for care; they’re a new model for the organization and delivery of the care under Medicare,” Dr. Donald Berwick, CMS administrator, said during a press con­ference to announce the proposed rule.

Dr. Berwick said he doesn’t know how many ACOs will form under the pro­gram, but that the level of interest is “enormous.”

Since the Affordable Care Act was passed last year, the health care com­
munity has been buzzing about how ACOs might be structured and if they could succeed in reducing health care costs. Integrated care organizations like Geisinger Health System in Danville, Pa., are considered to have a leg up because their hospital and outpatient care is already coordinated.

But Dr. Berwick said that the propos­al allows for ACOs at various levels of development to participate. For example, less developed ACOs can choose to re­ceive only shared savings for 2 years be­fore assuming risk. More mature organizations can assume risk immedi­ately but be eligible for greater levels of shared savings. “Our aim is to create on-ramps that will allow many to participate, depending on the different levels of maturity they are starting with,” Dr. Berwick said.

CMS officials estimate that the pro­gram could result in as much as $960 mil­lion in Medicare savings over 3 years.

<[stk -3]>Although federal officials said that they expect the coordinated care to pay divi­dends in savings to Medicare, ACOs will not be set up like HMOs. Medicare bene­ficiaries will still be able to see their choice of providers under fee-for-service Medicare. Providers will be the ones that enroll in ACOs and must notify patients they are receiving care within an ACO. <[etk]>

In addition to the ACO proposed rule, the Department of Justice and the Federal Trade Commission have also issued guidance on how physicians and hospi­tals that form an ACO can steer clear of antitrust laws. «http://www.ftc.gov/opp/aco» Officials at the CMS and the Office of the Inspector General have also issued a notice on potential waivers that could be granted in connection with the shared savings program, «http://www.ofr.gov/OFRUpload/OFRData/2011-07884_PI.pdf» and the In­ternal Revenue Service has issued new guidance for tax-exempt hospitals seek­ing to participate in the program.«http://www.irs.gov/pub/irs-drop/n-11-20.pdf»

I have checked the following facts in my story: (Please initial each.)

The CMS will be accepting comments on the proposed rule for 60 days<official publication date in the FR is April 7>. The agency also plans a series of open-door forums and listening sessions to explain the proposal and to get feedback from the public.