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The Final Federal Guidelines
By Garfunkel Wild PC
The much anticipated final federal regulations on accountable care organizations (ACOs) were published on October 20th, 2011. The Affordable Care Act created ACOs to deliver seamless, high quality care to traditional fee-for-service Medicare beneficiaries while reducing the cost of care to those beneficiaries. If successful, ACOs will receive a portion of the shared savings they achieve for the Medicare program.
ACO Workgroup
The Garfunkel Wild ACO Workgroup is in the process of analyzing these final regulations, and we will be hosting a webinar in the near future to discuss ACO participation and other ways providers can move towards collaborative care.
Final Regulations
In reviewing the final regulations, it is clear CMS took public comments to their proposed regulations seriously and made significant changes that should strengthen the ACO program. Some of these changes include:
- Allowing ACOs to participate in an upside shared savings track (without being subject to downside losses) for the first three years of participation
- Expanding the definition of participants eligible to form ACOs to include federally qualified health centers (“FQHCs”)
- Reducing by about half the number of quality measures ACOs have to report
- Permitting ACOs to share in first dollar saved once a minimum savings rate is achieved
- Creating more flexibility for start dates for ACOs beginning in 2012
- Removing EHR readiness as a condition of participation
- Revising the process of assigning beneficiaries to ACOs from a pure retrospective process to a prospective process that includes retroactive adjustments
Assessment
Also published with the CMS final regulations were interim final regulations published by the Office of Inspector General addressing the waiver of the application of federal fraud and abuse laws; a final policy statement issued by the Federal Trade Commission and Department of Justice outlining the agencies’ antitrust enforcement policies for ACOs, and an IRS Fact Sheet regarding tax exempt organizations participating in the Medicare Shared Savings program.
Conclusion
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Filed under: "Doctors Only", Health Law & Policy, Practice Management | Tagged: ACA, Accountable Care Organizations, ACO final regulations, ACOs, Affordable Care Act., CMS, federally qualified health centers, FQHCs, GarfunkelWild PC, Medicare Shared Savings program |
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 
Final CMS Rule
Here is a link to the CMS / HHS rule:
Click to access 2011-27461_PI.pdf
Ann Miller RN MHA
[Managing Editor]
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ACOS Could Financially Backfire – Duh!
Gail Wilensky, the former administrator of the Health Care Financing Administration, recently reviewed the results of the Physician Group Practice Demonstration Project, which is supposed to serve as a model for ACOs.
While the project showed that large group practices met quality standards designed to improve patient care, the practices had a much harder time reaching their financial goals.
Link: http://www.nejm.org/doi/full/10.1056/NEJMp1110185
In fact, in Wilensky’s words: “Even with all their experience, only two of the [Physician Group Practice] participants were able to exceed a 2% savings threshold the first year of the demo and only half managed to surpass that threshold after three years.”
While there are all sorts of variables to take into account here, the bottom line is obvious: If the big boys–including practices affiliated with the University of Michigan and Dartmouth–can’t get this right, how are the rest of the nation’s practitioners going to make accountable care happen?
Barton
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Just say NO … to medical payment bundling!
A new study published in Health Affairs raises questions about the feasibility of bundling.
The researchers, from the Rand Corporation and the Harvard School of Public Health, looked at three sites that were trying to implement a bundling methodology developed by the nonprofit Health Care Incentives Improvement Institute. (The method is called Prometheus.)
http://content.healthaffairs.org/content/30/11/2116.abstract
Arch
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The Informed Patient
[Tying Hospital Payments to Patient Satisfaction]
Hospitals are scrambling to improve customer service in advance of a change tying Medicare payments to higher scores on patient-satisfaction surveys, this Informed Patient column reports.
http://online.wsj.com/article/SB10001424052970204190704577023882771323656.html
THINK; Marcus Welby MD and bedside manner.
Ann Miller RN MHA
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ACOs
Higher costs – Lower quality?
http://thehealthcareblog.com/blog/2011/11/23/ftc-commissioner-accountable-care-organizations-will-likely-lead-to-higher-costs-and-lower-quality-health-care/
Edith
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ACO’s with a Medical Specialty Haircut
The problem with global medical capitation reimbursement, and ACOs, is the FFS payment system. And, there are two ways to put some distance between physicians and the incentives of FFS.
One is to put physicians on salary. The other is for FFS to go away, but this will give specialists a reimbursement hair cut; and not a good one.
In fact, for Pioneer ACOs, it will give haircuts in the third year, as explained in a recent Health Affairs/Robert Wood Johnson Foundation health policy brief, on ACOs.
Any thoughts?
Clay
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Well, Maybe Not!
Actually, physicians may be passing on accountable care organizations (ACO) and other alternative payment care models, Medscape just reported.
Only 3 percent of surveyed physicians from 25 specialty areas said they are participating in ACOs. Five percent, however, did report they plan to become involved in the coming year.
http://www.fiercehealthcare.com/story/physicians-say-no-thanks-risky-acos/2012-05-04#ixzz1tvQxHvRg
Now, are you surprised?
Donna
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Number of Medicare ACOs More Than Doubles
Medicare’s accountable-care experiment, which seeks to revamp how hospitals and doctors get paid, more than doubled in size, with 89 newly named participants. The CMS added the latest accountable care organizations to 27 ACOs in its shared-savings program, which offers medical groups, hospitals, and federally-qualified health centers financial incentives for quality improvement and cost control. An additional 38 organizations operate under other Medicare accountable care contracts.
“The Medicare ACO program opened for business in January, and already, more than 2.4 million beneficiaries are receiving care from providers participating in these important initiatives,” acting CMS Administrator Marilyn Tavenner said in a statement.
Source: Melanie Evans and Jessica Zigmond, Modern Healthcare [7/9/12]
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