Archive for ACO


Mandatory Payment Models Coming to Medicare?

Even as CMS rolls out new, voluntary Medicare alternative payment models, it is contemplating making participation in future models mandatory rather than voluntary, as is currently the case.

Or so Centers for Medicare & Medicaid Services administrator Seema Verma told a gathering in Baltimore last week.

At the heart of the idea, Verma told her audience, is that while CMS is pleased with participation in voluntary accountable care organization models, organizations are choosing to participate in ACO models they think would benefit them most while posing little or no downside financial risk.  The agency may need to move away from that approach to advance its efforts to transform more of Medicare into a value-based payment program.

Learn more in the Fierce Healthcare article “Verma: Trump administration mulling mandatory payment models.”

Adverse Selection May Explain Rising ACO Costs

Hospital ACO costs are rising because of the sicker patients they attract, a new study suggests.

According to researchers at University of Wisconsin Health, patients served by traditional Medicare or by physician-led accountable care organizations often switch to hospital-led Medicare ACOs as they encounter health problems, bringing those hospital-led ACOs sicker patients than those otherwise served by such organizations.  As a result, the per patient costs of hospital-led Medicare ACOs often rise more than those of the costs of traditional Medicare and physician-led ACOs.  Often, these shifts are encouraged by patients’ medical specialists.

Hospital-led Medicare ACOs have been criticized for their failure to control rising costs but this adverse selection may explain that failure, researchers found.

Learn more in the Health Affairs study “Hospital ACO costs are rising because of the sicker patients they attract, a new study suggests.”


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.…