Tag Archives: Accountable Care Organizations

OIG: “High-Performing” ACOs Point the Way for Medicare Shared Savings Program Savings

The OIG has examined the results of the first three years of the Medicare Shared Savings Program, under which accountable care organizations (ACOs) coordinate care to reduce Medicare costs and improve quality of care. The OIG reports that 428 participating ACOs serving 9.7 million beneficiaries saved almost $1 billion in net Medicare spending while generally … Continue Reading

2018 “Next Generation” Accountable Care Organization (ACO) Models

CMS is soliciting applications for 2018 Next Generation ACOs, an Innovation Center initiative intended to promote Medicare quality improvement and care coordination. Letters of intent are due May 4, 2017. CMS is holding a series of calls to discuss the model and the application process, including the following: March 14, 2017: Application Overview and Participating … Continue Reading

CMS Issues Final Mandatory Episode Payment Models for Cardiac and Orthopedic Cases, Plus New Cardiac Rehabilitation Incentive Payment Model and CJR Program Refinements

In the waning days of the Obama Administration, the Centers for Medicare & Medicaid Services (CMS) has unveiled a lengthy and complex final rule to establish mandatory Medicare bundled payment programs for acute myocardial infarction (AMI), coronary artery bypass graft (CABG), and surgical hip/femur fracture treatment (SHFFT) procedures furnished in designated geographic areas.  The rule … Continue Reading

CMS Announces Three New Innovation Models, Focusing on Patient Engagement and Dual-Eligible Population

The CMS Center for Medicare & Medicaid Innovation (CMMI) continues to launch initiatives to test ways to improve the quality of health care while controlling cost, despite an uncertain fate under the future Trump Administration and Republican-controlled Congress. Specifically, two new CMMI Beneficiary Engagement and Incentives (BEI) Models seek to promote “shared decision making,” which … Continue Reading

CMS to Cut Medical Review Audits for Certain Advanced Alternative Payment Model Participants

In order to improve “clinician engagement” and minimize administrative burdens, CMS has announced an 18-month pilot program to reduce medical review audits for participants in selected Advanced Alternative Payment Models (Advanced APMs), beginning January 1, 2017. Under this program, CMS will direct Medicare Administrative Contractors (MACs), Recovery Audit Contractors (RACs), and the Supplemental Medical Review … Continue Reading

CMS Proposes Three New “Episode Payment Models” for Cardiac Care, Hip/Femur Fracture Cases, Plus Changes to CJR Model

The Centers for Medicare & Medicaid Services (CMS) has announced proposals for three new “episode payment models” that, like the Comprehensive Care for Joint Replacement (CJR) model, would mandate provider participation in selected geographic areas. The episodes included in these payment models would address care for heart attacks, coronary artery bypass graft, and surgical hip/femur … Continue Reading

CMS Unveils New Mandatory Medicare Bundled Payment Models for Cardiac & Hip Fracture Cases, Plus Proposed Refinements to CJR Program

On July 25, 2016, CMS announced ambitious, multi-pronged plans to expand mandatory Medicare coordinated care/bundled payment programs, promote the use of cardiac rehabilitation services, refine current Comprehensive Care for Joint Replacement Model (CJR) rules, and integrate bundled payment programs into the upcoming Medicare physician quality/payment framework. The proposed “Advancing Care Coordination through Episode Payment Model” … Continue Reading

CMS Finalizes Changes to Medicare Shared Savings Program/ACO Benchmark Rebasing Rules

CMS has published a final rule that revises the methodology CMS uses to measure the performance of accountable care organizations (ACOs) in the Medicare Shared Savings Program. According to CMS, the changes are intended to encourage participation in the MSSP, under which more than 430 ACOs in 49 states and the District of Columbia currently … Continue Reading

CMS Schedules Calls on Medicare ACO Application Process (April 5 and 19)

CMS is holding two calls in April on the Medicare Shared Savings Program/Accountable Care Organization application process. The first call, scheduled for April 5, will focus on preparing for the Shared Savings Program application process for the January 1, 2017 program start date. The second call, to be held on April 19, will provide tips … Continue Reading

CMS Listening Session on Proposed Changes to Medicare Shared Savings Program Rules (March 3)

On March 3, CMS is hosting a “listening session” to receive feedback on proposed changes to the Medicare Shared Savings Program benchmarking methodology published on February 3, 2016. In particular, CMS invites comments on provisions addressing: Incorporation of regional fee-for-service expenditures into the methodology for resetting accountable care organizations’ (ACO) historical benchmark; Adjustments to an … Continue Reading

Extensive Medicare & Medicaid Funding and Program Integrity Provisions in Obama’s Released FY 2017 Budget Proposal

On February 9, 2016, the Obama Administration released its proposed fiscal year (FY) 2017 budget, which contains significant Medicare and Medicaid reimbursement and program integrity legislative proposals – including $419 billion in Medicare savings over 10 years. These proposed policy changes would require action by Congress, and Republican Congressional leaders have already voiced general opposition … Continue Reading

CMS Proposes Changes to Medicare Shared Savings Program/ACO Benchmark Rebasing Rules

On February 3, 2016, CMS published a proposed rule that would revise the methodology CMS uses to measure the performance of accountable care organizations (ACOs) in the Medicare Shared Savings Program (Shared Savings Program) in order to encourage participation in the program.  In particular, the proposed rule would modify the methodology CMS uses to reset … Continue Reading

Senate Passes Rural ACO Legislation

On December 17, 2015, the Senate approved S. 2261, the Rural ACO Provider Equity Act of 2015. This legislation would modify how beneficiaries are assigned under the Medicare shared savings program by considering services furnished by federally qualified health centers and rural health clinics. The policy would apply to performance years beginning on or after … Continue Reading

CMS/OIG Finalize Fraud Authority Waivers for Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program (MSSP)

The Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) have finalized a rule designed to “remove legal and regulatory barriers that can impede care coordination in furtherance of the Shared Savings Program” and “reduce burden on ACOs, ACO participants, and ACO providers/suppliers.”  Specifically, the rule allows ACOs, ACO participants, … Continue Reading

CMS Revises, Expands ACO “Investment Model” Opportunities

As previously reported, CMS announced a Medicare Shared Savings Program/Accountable Care Organization (ACO) “Investment Model” last fall to better coordinate care in rural and underserved areas where inadequate access to capital could hinder infrastructure development needed for successful population care management. On June 25, 2015, CMS announced that it is modifying the eligibility criteria for … Continue Reading

CMS Adopts Changes to Medicare Shared Savings Program/ACO Regulations

On June 9, 2015, CMS published a final rule revising the regulations governing the Medicare Shared Savings Program, which is intended to encourage physicians, hospitals, and certain other types of providers and suppliers to form Accountable Care Organizations (ACOs) to provide cost-effective, coordinated care to Medicare beneficiaries. According to CMS, the Shared Savings Program now … Continue Reading

OIG Releases FY 2015 Work Plan Mid-Year Update

The HHS OIG has updated its FY 2015 Work Plan to reflect new and/or completed items since release of its Work Plan in October 2014. Of note, the OIG has announced its plans to conduct several new Medicare reviews addressing: intensity-modulated radiation therapy; hospital preparedness and response to high-risk infectious diseases; access to DME in competitive … Continue Reading

Medicare Shared Savings Program Applications for January 1, 2016 Start Date

CMS is proceeding with the application process for the Medicare Shared Savings Program for the January 1, 2016 program start date. Applicants interested in participating must submit a Notice of Intent to Apply by May 29, 2015, and complete the application by July 31, 2015.  A CMS call regarding the Shared Savings Program application review process is … Continue Reading

CMS Touts Pioneer ACO Model Savings and Potential Expansion

On May 4, 2015, CMS announced that the Pioneer Accountable Care Organization (ACO) Model generated $384 million in savings to Medicare over two years. Under the Pioneer ACO Model, which was authorized by the ACA, health care organizations and providers with experience coordinating care across settings may share in Medicare savings generated if they meet … Continue Reading

CMS Calls on Next Generation ACO Model

CMS is hosting a series of calls to discuss its new “Next Generation” ACO Model, which is intended to promote Medicare quality improvement and care coordination. The following upcoming calls are scheduled: • March 31, 2015 — Focusing on financial methodology and related issues; • April 7, 2015 – Focusing on benefit enhancements and beneficiary care … Continue Reading

CMS Invites Stakeholders to Join “Health Care Payment Learning and Action Network” to Promote Alternative Payment Models

As previously reported, CMS has established a public-private partnership, the Health Care Payment Learning and Action Network, to support HHS’s goal of moving Medicare and the broader health industry from a FFS model towards alternative payment models that emphasize value. CMS is now inviting payers, providers, employers, purchasers, state partners, consumer groups, individual consumers, and … Continue Reading

CMS Announces New “Next Generation” ACO Model; Schedules 3/17 Call

On March 10, 2015, CMS announced the Next Generation Accountable Care Organization (ACO) Model, its latest Affordable Care Act (ACA) innovation initiative intended to promote Medicare quality improvement and care coordination. The Next Generation ACO Model differs from the existing Medicare Shared Savings Program and Pioneer ACO models in several ways. For instance, the Next … Continue Reading
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