Accountable Care Organization

Federal Health Policy Update for Monday, November 15

The following is the latest health policy news from the federal government as of 2:45 p.m. on Monday, November 15. Some of the language used below is taken directly from government documents. The White House The White House has posted a transcript of the November 10 press briefing given by its COVID-19 response team and public officials. Go here for the slides presented during that briefing. Centers for Medicare & Medicaid Services – Final Guidance on Shared/Co-Located Hospital Spaces In a memo to state survey agencies, CMS has published final guidance for the evaluation of compliance with the Medicare Conditions [...]

iqtsupport2021-11-15T17:19:23-05:00November 15, 2021|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Coronavirus, COVID-19, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare reimbursement policy|

CMS Funds Expanded Telehealth in Four States

The Centers for Medicare & Medicaid Services is building on its Community Health Access and Rural Transformation (CHART) Model by awarding up to $20 million to organizations in four states to expand the use of telehealth in their communities and introduce other improvements that enhance access to care in rural areas. Organizations in Alabama, South Dakota, Texas, and Washington state will receive $2 million for planning and up to $3 million each for achieving specific objectives. The CHART model seeks to use telehealth and other means, reimbursed through an accountable care organization model, to address health disparities and reduce hospital [...]

iqtsupport2021-10-21T06:00:15-04:00October 21, 2021|Accountable Care Organization, ACO, Alternative payment models, Telehealth|

Federal Health Policy Update for Monday, August 30

The following is the latest health policy news from the federal government as of 2:30 p.m. on Monday, August 30. Some of the language used below is taken directly from government documents. Temporary Suspension of COVID-19 Data Reporting Requirements for Some Hospitals The Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response has announced that federal hospital COVID-19 reporting requirements for the entire state of Louisiana and parts of Mississippi have been suspended for seven days in response to Hurricane Ida. While hospitals in the affected areas may still report their data if they [...]

iqtsupport2021-08-30T18:45:57-04:00August 30, 2021|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Coronavirus, COVID-19, MACPAC, Medicaid and CHIP Payment and Access Commission, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for Wednesday, July 14

The following is the latest health policy news from the federal government as of 2:45 p.m. on Wednesday, July 14. Some of the language used below is taken directly from government documents. CMS – Proposed 2022 Medicare Physician Fee Schedule Rule CMS has released its proposed Medicare physician fee schedule rule for 2022. Highlights of the proposed rule, which is more than 1700 pages, include: loosening current restrictions on the use of telehealth and expanding its use for behavioral health services; expanding the reach of the Medicare Diabetes Prevention Program; requiring clinicians to meet a higher performance threshold to receive [...]

iqtsupport2021-07-14T18:50:52-04:00July 14, 2021|Accountable Care Organization, ACO, Centers for Medicare & Medicaid Services, Coronavirus, COVID-19, MACPAC, Medicaid and CHIP Payment and Access Commission, Medicare regulations, Medicare reimbursement policy, Telehealth|

MedPAC Reports to Congress

MedPAC has submitted its annual report to Congress. The congressionally mandated report, titled Report to Congress: Medicare and the Health Care Delivery System, consists of seven chapters: Realizing the promise of value-based payment in Medicare: an agenda for change. Challenges in maintaining and increasing savings from accountable care organizations (ACOs). Replacing the Medicare Advantage quality bonus program. Mandated report: Impact of changes in the 21st Century Cures Act to risk adjustment for Medicare Advantage enrollees. Realigning incentives in Medicare Part D. Separately payable drugs in the hospital outpatient prospective payment system (OPPS). Improving Medicare’s end-state renal disease (ESRD) prospective payment [...]

iqtsupport2020-06-22T06:00:10-04:00June 22, 2020|Accountable Care Organization, ACO, Medicare, Medicare reimbursement policy, MedPAC|

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s March agenda were: Addressing Medicare Shared Savings Program vulnerabilities The role of specialists in alternative payment models and accountable care organizations Realigning incentives in Medicare Part D Redesigning the Medicare Advantage quality bonus program Mandated report: Impact of changes in the 21st Century Cures Act to risk adjustment for Medicare Advantage enrollees Improving Medicare’s end-stage renal disease prospective payment system Separately payable drugs in the hospital outpatient prospective payment system MedPAC is an independent congressional agency that advises [...]

iqtsupport2020-03-09T09:40:54-04:00March 9, 2020|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s January agenda were: The Medicare prescription drug program (Part D): status report and options for restructuring Redesigning the Medicare Advantage quality program: initial modeling of a value incentive program Hospital inpatient and outpatient payments Physician payments Outpatient dialysis payments Skilled nursing facility, home health, inpatient rehabilitation facility, and long-term-care hospital payments Hospice and ambulatory surgery center payments The 340B program ACO beneficiary assignment MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program. [...]

iqtsupport2020-01-22T06:00:06-05:00January 22, 2020|Accountable Care Organization, ACO, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

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 [...]

iqtsupport2019-05-02T06:00:59-04:00May 2, 2019|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Medicare, Medicare reimbursement policy|

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 [...]

iqtsupport2019-04-29T10:11:51-04:00April 29, 2019|Accountable Care Organization, ACO, Alternative payment models, Medicare|

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 [...]

iqtsupport2019-01-17T06:00:00-05:00January 17, 2019|Accountable Care Organization, ACO, Alternative payment models, Medicare, Medicare reimbursement policy|