Archive for Accountable Care Organization

 

New ACO Incentive: Exemption From 3-Day Stay SNF Requirement

In an effort to encourage more Medicare accountable care organizations to assume financial risk for the care of their patients, the Centers for Medicare & Medicaid Services is extending its exemption from the three-day inpatient stay requirement before Medicare ACOs can discharge their patients to skilled nursing facilities to ACOs participating in selected ACO model programs that involve two-sided risk under preliminary prospective assignment with retrospective reconciliation.

This move expands the waiver from the three-day SNF requirement that ACOs that assume greater financial risk already receive.

Details about the new policy, including the ACO models that qualify for this exemption and the conditions under which those ACOs can gain exemption from the three-day inpatient stay requirement, can be found in the new CMS guidance document Medicare Shared Savings Program:  SKILLED NURSING FACILITY, 3-DAY RULE WAIVER.…

CMS Revamps Medicare ACO Program

The federal government seeks to pursue greater savings and an accelerated approach to value-based care through an overhaul of its programs for Medicare accountable care organizations.

The Centers for Medicare & Medicaid Services’ new “Pathways to Success” program seeks to speed up the process of providers assuming risk for costs and outcomes through the following changes from the agency’s current approach.

  • A reduction in how long participating ACOs can remain in the program without assuming some responsibility for their spending.
  • Modifications that CMS hopes will encourage physician groups to remain independent of hospitals and health systems.
  • Greater flexibility to innovate in exchange for participating in performance-based risk.
  • Permission to offer new incentives to patients to take greater responsibility for their own health.
  • Incorporation of regional spending differences when setting individual ACOs’ target spending and to foster greater alignment with Medicare Advantage programs.

Learn more about CMS’s new Pathways to Success Program for Medicare ACOs by reading this program announcement and the regulation detailing how the ACO program will change.…

Next Generation ACO Nets Savings

Medicare’s Next Generation Accountable Care Organization model saved taxpayers $62 million in 2016, or 1.1 percent of the spending of the participating organizations, the Centers for Medicare & Medicaid Services has announced.

The program also reduced hospitalizations 1.3 percent.

In all, 18 organizations participated in the model program in 2016.  Among them, four organizations accounted for more than half of the savings.

In 2015, 45 organizations participated in the model and 51 are participating this year.  Under the Next Generation ACO model, participants assume greater financial risk for their performance than under other Medicare models but also are eligible to gain a greater proportion of the savings they produce.

Learn more about performance under the Medicare Next Generation ACO model from this CMS news release, this summary of program highlights, and the full CMS report on 2016 program performance.…

MedPAC Issues 2018 Report to Congress

The non-partisan legislative branch agency that advises Congress and the administration on Medicare payment policies has submitted its mandatory annual report to Congress.

Among the findings included in the report by the Medicare Payment Advisory Commission are:

  • Medicare’s hospital readmissions reduction program has not resulted in increases in emergency room visits or hospital observation stays.
  • Many Medicare accountable care organizations, while maintaining or improving quality, are producing more modest savings than predicted.
  • MedPAC approves of Medicare’s proposals to redesign the case-mix classification system for skilled nursing facilities.
  • MedPAC supports changes Medicare has proposed for patient assessment and therapy requirements for skilled nursing facilities.

MedPAC’s recommendations include:

  • Authorizing outpatient-only hospitals in isolated rural communities to ensure access to emergency care.
  • Reducing payments to off-campus emergency departments in certain urban areas.
  • Rebalancing Medicare’s physician fee schedule to increase payments for ambulatory evaluation and management services while reducing payments for procedures, imaging, and tests.
  • Paying for sequential stays in a unified prospective payment system for post-acute care.
  • Establishing new ways to help patients, families, and hospitals identify higher-quality post-acute care providers for their patients.
  • Establishing new principles for measuring quality that address both population-based measures and quality incentives.
  • Encouraging the development of managed

ACOs Moving Into Medicaid

Accountable care organizations, one of the centerpieces of recent Medicare efforts to test new ways to deliver care more effectively and at less cost, are finding their way into state Medicaid programs as well.

Today, a dozen states employ Medicaid ACOs and another ten are planning to do so.

Learn more about Medicaid ACOs, and how one state (Minnesota), in particular, is using them, in this Kaiser Health News report.…