Tag Archives: Medicare Shared Savings Program

CMS APPROVES 106 NEW ACCOUNTABLE CARE ORGANIZATIONS

On January 10, 2013, the Centers for Medicare & Medicaid Services (“CMS”) announced that it selected 106 new Accountable Care Organizations (“ACO’s”) to participate in the Medicare Shared Savings Program. CMS Acting Principal Deputy Administrator Jonathan Blum blogged about the aim of ACO’s and described them as having the potential to improve the US health […]

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Health Care Innovation in the Medicare Program: Value-Based Initiatives Beyond Accountable Care Organizations

by René Y. Quashie and Lynn Shapiro Snyder

As the health care industry analyzes the recently released final rule and related guidance regarding the Medicare Shared Savings Program (“MSSP”) for accountable care organizations (“ACOs”), it is important for the industry to also pay attention to key deadlines related to initiatives being implemented by the Center for Medicare and Medicare Innovation (“CMMI” or “Innovation Center”) within the Centers for Medicare & Medicaid Services (“CMS”).

While the MSSP ACO initiative is a permanent Medicare program, CMMI is developing and promoting other initiatives—some related to the MSSP, others not—which should be part of any provider’s considerations related to the “Medicare Menu” of options now available to customize an entity’s Medicare payment methodologies. This alert will address a number of key Medicare initiatives currently under way at the Innovation Center and another to be implemented by the Center for Medicare within CMS.

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HEALTH REFORM: Health Care Innovation in the Medicare Program: Value-Based Initiatives Beyond Accountable Care Organizations

As the health care industry analyzes the recently released final rule and related guidance regarding the Medicare Shared Savings Program (“MSSP”) for accountable care organizations (“ACOs”) (see Epstein Becker Green’s Implementing Health and Insurance Reform alert of October 27, 2011, here), it is important for the industry to also pay attention to key deadlines related to initiatives being implemented by the Center for Medicare and Medicare Innovation (“CMMI” or “Innovation Center”) within the Centers for Medicare & Medicaid Services (“CMS”).

By way of background, the MSSP is being implemented under the Center for Medicare within CMS. The Innovation Center is a new center organized under CMS, and has a different mission, organizational structure, and leadership than the Center for Medicare. The Innovation Center was created under the 2010 Patient Protection and Affordable Care Act (“ACA”) to test innovative payment and service delivery models to reduce program costs, while also preserving the quality of care for Medicare, Medicaid, and CHIP beneficiaries. Funding in the amount of $10 billion already was provided to the Innovation Center through fiscal year 2019.

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HEALTH REFORM: Revisiting the Medicare Shared Savings Program: An Interagency Effort to Promote Accountable Care

On October 20, 2011, the Centers for Medicare & Medicaid Services (“CMS”) released its final rule (“Final Rule”) implementing the voluntary Medicare Shared Savings Program (“Program”) for accountable care organizations (“ACOs”). The Program was established by Section 3022 of the Patient Protection and Affordable Care Act. The Final Rule was released in conjunction with revised antitrust guidance from the Federal Trade Commission (“FTC”) and the Department of Justice (“DOJ”), as well as with the establishment by CMS and the Department of Health and Human Services’ Office of Inspector General (“OIG”) of several waivers from various fraud and abuse laws. As part of this interagency effort to facilitate participation in the Program, the Internal Revenue Service (“IRS”) also issued a fact sheet regarding nonprofit organizations’ participation in ACOs.

Click here to download the entire alert in PDF format.

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HEALTH REFORM: Overview of Methodology for Determining PSA Shares for Accountable Care Organizations Participating in the Medicare Shared Savings Program

On April 19, 2011, the “Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program” (“Proposed Statement”) was published in the Federal Register.[1] The public was given the opportunity to submit comments regarding the Proposed Statement by May 31, 2011.

The Proposed Statement protects Medicare-approved accountable care organizations (“ACOs”) participating in the Medicare Shared Savings Program (“MSSP”) from per seenforcement of the antitrust laws and establishes criteria for evaluating an ACO’s risk of an antitrust law challenge from the Federal Trade Commission (“FTC”) and the Department of Justice (“DOJ”) under a “rule of reason” analysis. Among the criteria used to evaluate an ACO’s risk of an antitrust challenge is the ACO applicant’s “market share” within each of its service lines. The market share is a measure of the share of services an ACO participant provides in its Primary Service Area (“PSA”) relative to other providers. The share of services that each ACO participant provides in its PSA – which is referred to as the participant’s “PSA share” – is the key factor that the agencies are proposing to use for determining whether an ACO will receive “Safety Zone” protection from the antitrust laws or be subject to mandatory expedited review from the agencies in order to participate in the MSSP. Consequently, most organizations that are considering forming ACOs will need to calculate the PSA shares of their participant-providers.

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Awaiting the Medicare Shared Savings Program Regulations: Progress on the Road to Accountable Care?

by Douglas A. Hastings

According to the Administrator of the Centers for Medicare & Medicaid Services (“CMS”), Dr. Donald M. Berwick, the long-awaited proposed regulations implementing the Medicare Shared Savings Program should be out soon. Given the incredible proliferation of policy, business, and legal thinking about accountable care organizations (“ACOs”) that has taken place since the passage of the Affordable Care Act (“ACA”) less than a year ago, CMS’s initial effort to describe a program of payment and delivery reform built around the ACO “model” will contribute importantly to the national dialogue on accountable care and will give providers a first look at CMS’s detailed requirements for the Medicare Shared Savings Program.

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HEALTH REFORM: Awaiting the Medicare Shared Savings Program Regulations: Progress on the Road to Accountable Care?

According to the Administrator of the Centers for Medicare & Medicaid Services (“CMS”), Dr. Donald M. Berwick, the long-awaited proposed regulations implementing the Medicare Shared Savings Program[1] should be out soon. Given the incredible proliferation of policy, business, and legal thinking about accountable care organizations (“ACOs”) that has taken place since the passage of the Affordable Care Act (“ACA”) less than a year ago, CMS’s initial effort to describe a program of payment and delivery reform built around the ACO “model” will contribute importantly to the national dialogue on accountable care and will give providers a first look at CMS’s detailed requirements for the Medicare Shared Savings Program.

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Five Wishes for the Medicare Shared Savings Program Regulations

As the health care world awaits the Medicare Shared Savings Program regulations expected to be issued soon by CMS, below is a wish list for key attributes that I hope the regulations evidence:

1. Flexibility.

 

“Transforming health care everywhere starts with transforming it somewhere.” I hope that CMS takes Atul Gawande’s advice and avoids being too proscriptive in launching the Share Savings Program. To me, the biggest risk to the program is being deemed a failure for having gone down too narrow a path that turns out to be unsuccessful.

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