Oct. 24, 2011

CMS Radically Revamps ACO Rules, Providers Pleased

CMS rolled out its new version of ACOs last week and made significant changes to the program it had announced five months ago. The program starts January 1, 2012, but there are several opportunities to join during the year. Some of the big changes:

  • EHR – Meaningful Use requirements – no longer a condition of participation
  • Shared savings begins with first dollar, not after 2% given to the government
  • 33 quality measures instead of 65
  • Prospective rather than retrospective assignment
  • No risk option in Track 1
  • Five anti-trust and stark waivers offered
  • No mandatory, upfront anti-trust review
  • FQHCs and rural health clinics may now lead ACOs

To review the FTC/DOJ changes, click here.
For a detailed summary on the new ACO program, click here.
Click here to see the methodology used to determine shared savings and losses.

CMS also announced the Advanced Payment model ACO. Click here for details.

Our policy and legal teams are now prepared to help your organization walk through a detailed review of the new ACO regs. If you are interested in providing your executive team with a comprehensive overview, please email me, Paul Lee, Senior Partner with Strategic Health Care, Paul.Lee@shcare.net. In our view, CMS is working hard to move away from fee-for-service Medicare – whether under a Democratic or GOP administration. This latest ACO program may be an excellent way for your organization to prepare for the transition.

Hospital and physician organizations issued press releases lauding the changes in the program. It was criticized by the largest insurance industry association (AHIP) because of the new DOJ/FTC flexibility (click here) and the medical device association expressed many concerns (click here).

CMS Proposes Major Changes to Medicare’s Conditions of Participation

The proposed rule is designed to reduce regulatory mandates, including:  eliminating burdensome requirements that do not permit hospital patients or their caregivers/support persons to administer certain medications; allowing hospitals to determine the best ways to oversee and manage outpatients by removing the unnecessary requirement for a single Director of Outpatient Services; increasing flexibility for hospitals by allowing one governing body to oversee multiple hospitals in a single health system; enabling hospitals to have a single, interdisciplinary care plan that supports coordination of care instead of requiring a separate stand-alone nursing care plan; allowing CAHs to provide certain services, including laboratory and radiology services, under arrangement. A copy of the 75-page rule can be viewed here. A summary can be seen by clicking here.

Docs to Get Smaller Pay Increases in 2012

A new report shows physicians across all organizations can expect smaller salary increases in 2012. Click here for details.

Massachusetts Developing Global Payment Plan

Massachusetts legislators don’t believe they’ve gone far enough with health care reform and are working toward a plan that would encourage flat “global payments” to networks of providers for keeping patients well, replacing the fee-for-service system that creates incentives for excessive care by paying for each visit and procedure. Click here for the NY Times story.

Hospital Infection Rate Falling: HHS

HHS officials last week announced that hospital acquired infections – at least those targeted by the government — are declining. They found a 33 percent reduction in central-line infections. Infections caused by catheters used to collect urine from bed-bound patients fell by 7 percent in 2010; surgical-site infections fell 10 percent; and MRSA infections fell 18 percent. Click here to review the latest data.

Employers Won’t Drop Employee Coverage:  New Study

A new study from the Urban Institute, funded by Robert Wood Johnson, refutes a study earlier this year from McKinsey saying that employers would drop coverage for their employees under the Affordable Care Act. Click here to review the report.

Health Reform Helps Keep Money in Most Pockets:  New Study

A new report details the financial savings the Affordable Care Act will bring to families over the next several years. Families USA says households with incomes less than $100,000 will receive the greatest benefit. Click here to review the 20-page study in PDF format.

CMS Starts Innovation Advisors Program

CMS announced it was looking for as many as 200 people to join its Innovation advisors program during 2012. The program is designed to help create a national network of transformation experts who will work within their communities and organizations to reform the delivery system. Applications are due November 15. Click here for details.

Report: Most Beneficiaries Can Access 4 or 5 Star Plan

We mentioned that 9 health plans got a 5-star rating from CMS for 2012 - six more than last year. There are a number of other details that consulting firm Avalere identified in the government’s report that you might find interesting. Click here to see their 7-slide PDF presentation.

Senators Seek Change to FDA Advisory Panels

Sens. Klobuchar, D-Minn., Bennet, D-Colo., and Burr, R-N.C., have introduced a bill that would roll back a 2007 law that bans experts with industry ties from serving on FDA advisory panels without a waiver. Click here for more.

American Health Care System Still Struggles:  New Report

So, how is the American health care system doing these days? A new study from the Commonwealth Fund says it’s not doing quite as well as it did in the previous couple of years. The study makes comparisons of our health system between 2003 and 2009 - all before the Affordable Care Act. Click here to see the 84-page PDF report.

Imaging Utilization Programs Don’t Save Much $$$:  New Study

A national medical imaging coalition was out last week with a study it financed that concludes that utilization management and prior authorizations programs don’t achieve the financial savings that may be expected by the government. Click here for a copy of the 14-page PDF document.