Medicare accountable care organizations

CMS Tinkers With ACO REACH Model

Medicare’s ACO REACH Model will undergo some changes when it heads into its 2025 performance year. To help ensure that the program controls costs and saves money, the Centers for Medicare & Medicaid Services will implement a series of changes in its voluntary Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model. According to the agency, it is: adjusting the financial methodology to improve model sustainability based on the findings in the PY [performance year] 2022 Evaluation Report; responding to feedback from interested parties on improvements to the accuracy of benchmarks; and strengthening operational flexibility and [...]

joe2024-08-13T15:57:16-04:00August 14, 2024|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for April 25

The following is the latest health policy news from the federal government for April 9-25. Some of the language used below is taken directly from government documents. Updated 340B Arbitration Process Last week HHS’s Health Resources and Services Administration (HRSA) published a regulation modifying the administrative dispute resolution (ADR) process it uses to adjudicate payment disputes between 340B-eligible providers and pharmaceutical companies. The major changes in the ADR process include the use of HRSA experts to serve on ADR panels; elimination of the $25,000 damage threshold for filing a claim; 340B-eligible providers may now challenge manufacturers that seek to prevent [...]

joe2024-04-25T20:25:44-04:00April 25, 2024|340b, Accountable Care Organization, ACO, Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicaid long-term services and supports, Medicaid managed care, Medicaid regulations, Medicaid regulations for long-term care, Medicaid regulations for the disabled, Medicare, Medicare post-acute care, Medicare regulations, post-acute care|

Federal Health Policy Update for Tuesday, June 21

The following is the latest health policy news from the federal government as of 2:45 p.m. on Tuesday, June 21. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services The Supreme Court has ruled that CMS acted inappropriately when it reduced 340B payments to hospitals. In a unanimous decision, the court found that the law creating the program gives the federal government two ways to set 340B payments for outpatient drugs for qualified providers and that the manner in which CMS cut those payments in 2018 followed neither. Learn more from [...]

iqtsupport2022-06-21T17:24:52-04:00June 21, 2022|340b, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, COVID-19, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

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|

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|

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 [...]

iqtsupport2018-12-31T06:00:14-05:00December 31, 2018|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Medicare regulations, Medicare reimbursement policy|

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 [...]

iqtsupport2018-06-21T10:33:14-04:00June 21, 2018|Accountable Care Organization, ACO, hospitals, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, MedPAC, post-acute care|

MedPAC Meets

Last week the Medicare Payment Advisory Commission held two days of public meetings in Washington, D.C. During the sessions MedPAC, a non-partisan legislative branch agency that advises Congress on Medicare payment issues, addressed the following subjects: a Medicare Advantage status report a Medicare prescription drug program (Part D) status report hospital inpatient and outpatient payments physician payments ambulatory surgical center, dialysis center, and hospice payments post-acute care facility payments the hospital readmissions reduction program telehealth accountable care organizations Go here to see the issue briefs and presentations used during the meetings.

iqtsupport2018-01-18T06:00:18-05:00January 18, 2018|Accountable Care Organization, ACO, Medicare, Medicare post-acute care, MedPAC|