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Proposed Federal Regulations for ACOs

10 Responses

1. Ann Miller RN MHA, on May 3, 2011 at 12:11 PM said:

   Proposed CMS Rules for ACOs

   Click to access ACO_NPRM_Summary_Factsheet_ICN906224.pdf

   Ann Miller RN MHA
   [Executive-Director]

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2. Ann Miller RN MHA, on May 6, 2011 at 3:07 PM said:

   Bill Would Exempt Doctors from Antitrust Laws

   On April 7th 2011, Rep. John Conyers (D-MI) introduced H.R. 1409, the Quality Health Care Coalition Act of 2011.

   The bill would exempt from federal antitrust laws any healthcare professional engaged in negotiations with a health plan regarding the terms of any contract.

   Currently, the insurance industry, including any healthcare insurance company, is immune from federal antitrust laws under the McCarran-Ferguson Act. In contrast, healthcare providers can presently be prohibited from collectively negotiating with insurance companies.

   H.R. 1409, if enacted, would give healthcare providers the ability to collectively negotiate contractual terms with insurers, including provisions that affect the quality of patient care, and would put them on the same footing as other collective bargaining units immunized under the National Labor Relations Act.

   Source: APMA News Brief [5/5/11]

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3. Hope R. Hetico RN MHA, on May 25, 2011 at 10:31 AM said:

   But – why do we need ACOs?

   Click to access ACO.pdf

   Hope R. Hetico RN MHA

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4. Jeff, on May 31, 2011 at 1:55 PM said:

   Advanced Health IT Needed For ACO Initiatives

   Data analytics tools, clinical applications, and other technologies technologies can help accountable care organizations deliver on the promise of quality improvement and cost cutting.

   http://www.informationweek.com/news/healthcare/clinical-systems/229700076

   Jeff

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5. Jeff, on June 1, 2011 at 10:29 AM said:

   Medicare ACO Options Added After Criticism

   The Obama administration has offered new options for Medicare accountable care organizations to entice wary physicians and other health care professionals to participate in the shared savings concept. The Center for Medicare and Medicaid Innovation on May 17th unveiled a pioneer ACO model for doctors and hospitals that are deemed ready to start coordinating their Medicare patients’ care as soon as October instead of waiting until January 2012.

   The Centers for Medicare & Medicaid Services, which runs the innovation center, also floated an idea to provide potential ACO participants with startup capital and four training seminars. Through care coordination and a shared savings — and shared risk — concept, Medicare officials hope to encourage more efficient, higher quality care in the program.

   Source: Charles Fiegl, AMNews [5/30/11]

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6. Darrell K. Pruitt DDS, on June 15, 2011 at 5:17 PM said:

   Does anyone find this scary?

   “EHR Association supports ACO proposals – with more IT”

   “The concept of the ACO, with provider accountability for cost containment and quality improvement, represents a real effort towards building a new value-driven healthcare system to address the critical shortcomings in the current payment model.”

   – Leigh Burchell
   Vice president of government affairs and public policy for Allscripts (MDRX) and chair of the EHR Association’s Public Policy Leadership Work Group.

   http://www.healthcareitnews.com/news/ehr-association-supports-aco-proposals-more-it

   Darrell

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7. Ted, on September 23, 2011 at 10:19 AM said:

   The ‘Big Boys’ Pass on Pioneer ACO Program!

   During the health care debate, the Mayo Clinic, the Cleveland Clinic, Geisinger Health System and Intermountain Healthcare were repeatedly touted as models for a new health care delivery system.

   Now, they have something else in common: All four have declined to apply for the “Pioneer” program tailor-made by the Obama administration to reward such organizations.

   http://www.govhealthit.com/news/poster-boys-take-pass-pioneer-aco-program

   Ted

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8. Ann Miller RN MHA, on October 20, 2011 at 10:09 PM said:

   Final ACO Regs Include Bigger Bonuses

   Medicare accountable care organizations could see larger bonuses and face fewer quality measures under rules proposed by the CMS. In final rules for Medicare accountable care organizations, published just today, the CMS said it would no longer require all ACOs to face potential penalties, and it increased possible bonuses. The final rule also proposed half the number of quality measures included in draft rules released last March. Under accountable care, healthcare providers that reach quality and cost-saving targets are eligible to share in the savings.

   The CMS also proposed an advanced-payment program for small physician-owned and rural hospitals that lack capital to start an accountable care group. Under the program, up to 50 small ACOs will quality for upfront payments that will be paid back as providers reduce Medicare costs. The Center for Medicare and Medicaid Innovation will award up to $170 million under the program.

   Source: Melanie Evans, Modern Healthcare [10/20/11]

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9. Cyndy Nayer, on February 28, 2015 at 12:46 PM said:

   Values Based Healthcare

   The greatest challenge is, in a few words, getting to metrics that are meaningful for all the parties.

   It may be best to start with story behind paying for value. In this case, I had created a slide deck for a 2009 conference that no one else wanted to present. So, I proposed the idea in a conference room with about 100 people. I showed the connection between patient-centered medical homes and value-based benefit designs. Then I showed a slide that said it simply didn’t make sense to create rewards for adherence to screenings, treatments, and visits for chronic care management without creating parallel incentives for the providers, plans and product developers. I haven’t wavered since that time.

   In order to have a system, everyone has to see the goal and how to get there. Just as patient engagement doesn’t mean anything without the patient, system transformation means little without a system. All 18 wheels on the truck must be in alignment to get from pickup to drop off. All members on the field must see and move toward the goal. And all people and processes involved in the value-based initiatives must agree on the goals and metrics, which probably will be sequenced over time, as well as communicate to the goals to the related parties, such as fitness trainers, nutritional counselors, and care coordination teams.

   In each of the outcomes-based or value-based contracts that came out over the years after the presentation, the metrics for first year included patient behaviors such as scheduled visits, adherence to medications, and timely screenings. In a few instances, there were metrics to be met by the treatment providers (product manufacturers), such as guarantees of product claims and education for patients. But there were few contracts wherein the plan sponsor or the health system was also held accountable.

   Now, it’s time to close the loop on the system transformation. So here are the steps that are imperative to consider:

   1. What metrics can be achieved in the first year? This cannot and must not be checked boxes in the processes only. Rather, first year goals may be higher rates of adherence to evidence-based guidelines for chronic care, such as medications, yes, but also flu/pneumonia and other vaccinations needed, foot and eye exams (in the case of diabetics, as an example), medication adherence rates that go above 70% or 10-20% above current values, number of consultations with key assets (nutrition, exercise, financial counseling, job and home security).

   NOTE: these last 2 items are influenced by the IOM report that we must consider social determinants and not only clinical stoppers to better health. I must admit that I’ve been writing and calling for financial and job counseling for many years now.

   2. Second year? If a system were to start today, it would, according to meaningful use rulings, have to deploy interoperability in their data systems by 2017. So, we should expect the same and pay for the same to those who get there fastest. Health Info Technology has always held the promise of scalability and accuracy. Now, we need to accelerate the adoption beyond pedometers and sleep measures. We must build achievable metrics into the more complex HIT that will be used to manage and control complex conditions, from hepatitis to cancer to mental health issues.

   Also, by the second year, we should see rapid ramp up in hospital and device safety and significant decreases in avoidable admissions. Both of these, but especially avoidable admissions, will benefit from financial and home security counseling.

   3. Third year? This is the optimal year for seeing improvement. We now have the ability to measure the population improvement through 2 years of testing, counseling, and coordination of care beyond medication adherence.

   It’s also the year of goal or no-goal for the system: if the parties in the contract, health plan and health system, have achieved their multiple goals, then service will be streamlined (no more long waits, for example, and much fewer redundant tests) and patient/consumer experience will be elevated. Providers should also be more satisfied with results and have new ideas for unresolved engagement/adherence. The metrics will be more individualized to system competencies and patient engagement.

   I hope this helps. In 2010 I published the framework for considering the outcomes-based contract, which we now call the value-based purchasing. Transparency, interoperability, and open data for the patient were important then, and they are now. The trusted conversation and concomitant rewards for the patients and system participants are definable, achievable, and close at hand.

   Cyndy Nayer
   [President – CyndyNayer.com]
   Founder/CEO of Center of Health Engagement

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10. Corky, on October 17, 2017 at 6:33 PM said:

    NAACOS & Leavitt Partners: Top 13 Areas of Focus for ACO’s in 2017
     
    1.Prevent readmissions/transt. care improvement – Approx. 58%
    2.Management of chronic conditions – Approx. 56%
    3.Prevent. ED visits/inpatient admissions – Approx. 54%
    4.Post-acute care integration – Approx. 35%
    5.Mental health care integrations – Approx. 18%
    6.End-of-life care assessment – Approx. 16%
    7.Pharmacy or medication adherence – Approx. 14%
    8.Patient engagement – Approx. 12%
    9.Palliative care – Approx. 11%
    10.Overuse of speclty./redund. imaging & diagnostics – Approx. 10%
    11.Surgical care standardization – Approx. 3%
    12.Supply chain efficiencies – Approx. 3%
    13.Long term care integration – Approx. 3%

    Notes: The survey gathered responses from 240 unique ACOs.

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