CMS Releases New Proposal To Improve ACOs

CMS recently released a proposal to strengthen the Shared Savings Program for Accountable Care Organizations (ACOs) by placing greater emphasis on primary care services and promoting transitions to performance-based risk arrangements. CMS is seeking to continue this dialogue to ensure that the Medicare Shared Savings Program ACOs are successful in providing seniors and people with disabilities with better care at lower costs. The proposed rule is part of CMS’ continued commitment to reward value and care coordination, rather than volume and care duplication. CMS encourages doctors, hospitals and other healthcare providers to work together to better coordinate care, which can ultimately reduce healthcare costs and improve outcomes.

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Stark Law & Anti-Kickback Waivers Extended For ACOs

The Office of the Inspector General and CMS recently announced that waivers to the Anti-Kickback Statute and Stark Law for Medicare Shared Savings Program accountable care organizations will be extended through November 2, 2015. CMS and the OIG published an interim final rule with a comment period that established waivers of the applications of Stark Law, the Anti-Kickback Statute and certain civil monetary penalties to ACOs participating in the Shared Savings Program on November 2, 2011. According to the interim final rule, the waivers were to expire next month. Extending the waivers will support agencies’ goals “to balance effectively the need for ACO certainty, innovation, and flexibility in the Shared Savings Program with protections for beneficiaries and the Medicare program.”

Click here to see the interim final rule.

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Study: RNs Increasingly Delay Retirement

According to a new study by the RAND Corporation, the “current number of working registered nurses has surpassed expectations in part due to the number of baby-boomer RNs delaying retirement.” The RN workforce reached 2.7 million in 2012 and has continued growing. Nurses delaying retirement accounted for an extra 136,000 RNs in 2012. RAND researchers note that shifts in retirement benefits, as well as “economic uncertainty in general,” may have contributed to the decision to extend their careers.The surge in RNs could have significant implications on patient care; many RNs in their 60s often choose to leave hospital-based positions for primary care posts. ACOs, which are formed to better manage patient care, could benefit from the rise in RNs who seek non-hospital jobs. Specifically, the experience RNs have managing and coordinating care can help with what an ACO is trying to do.

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CMS: ACO Proposed Rule Coming Soon

CMS officials have announced that a proposed rule addressing changes to the Accountable Care Organizations program is coming soon. CMS “expects future success and collaboration with ACOs” although no details have been released yet about the proposed rule. There are now more than 360 ACOs as part of the Medicare Shared Savings Program-a program formed under the ACA to organize improved coordination of patient care and shared savings among physicians, hospitals and healthcare providers.

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Tiptastic Tuesday: 4 Strategies for Provider Success

In the ever-changing world of healthcare, providers must learn to adapt to new changes and innovations. According to an article from Strategy + Business, healthcare consumerization and the evolution of risk is shifting from payers to providers with patients gaining more control and choice over their care. In order to to become successful in the new healthcare climate, providers must manage risk by switching care delivery models toward bundled payments, accountable care organizations and other quality-centered initiatives.

Here are four strategies for provider success:

  1. Determine operation focus. Providers must determine how they want to compete in the current market, whether it be as a high-volume, low-cost institution, or as a center for excellence in a niche market, with higher-cost specialty care.
  2. Reduce cost of care. Providers should maintain quality standards while finding new ways of cutting costs by approximately 20 percent to 25 percent in the clinical and administrative sectors.
  3. Create patient-centered care models. Patient experience is important in a quality-driven market. Providers should consider bundled payments and population management which are radically different approaches to care that require correspondingly large changes in operations, including better integration of hospitals, outpatient facilities, and long-term care options into a single continuum of care.
  4. Manage the transition. Although it may be challenging to switch from fee-for-service models to quality care models, providers should make an effort to strike a balance between both approaches and shift the balance over time.

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New Medicare Data Shows Differences in ACOs’ Patient Care

CMS has released the first public numbers from Medicare of how patient care is being affected by specific networks, most of which are Accountable Care Organizations (ACOs). ACOs are the most prominent of Medicare’s experiments to change the way physicians and health care facilities work together and are paid. Medicare is tracking 33 different quality measures to see how well doctors coordinate with each other and whether patients are receiving the appropriate services.

Last Friday, CMS released data on five of these measures for 141 ACOs during 2012. Four of these measures evaluated how well the ACOs helped patients with diabetes, and the fifth measure examined how many patients with arteries packed with plaque received appropriate medicines to relax their blood vessels.

According to expert analysis of the data, the average ACOs reached their Medicare goals for 65 percent to 75 percent of their patients, depending on the measure.  ACOs did not perform as well as the 66 medical groups that are part of another Medicare quality program (click here to see those results).

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Do Bigger Hospitals Mean Better Care?

In a recent opinion piece on Bloomberg, it is argued that bigger hospitals only mean higher prices, not better care. Hospitals that merge with other hospitals and buy up groups of doctors claim that size brings efficiency and the opportunity for more value-based care but the authors argue that there is no evidence to prove that bigger hospitals offer better care.

The Dartmouth Atlas of Health Care and other sources have proved numerous times that some of the biggest and most well-known hospitals subject their patients to “useless tests and marginal treatments.” In a 2010 analysis for the Massachusetts attorney general, there was no correlation between price and quality of care; a Health Affairs study had similar results for the rest of the country. In reality, the authors argue, bigger hospitals are the highest priced, not the best, and with specialists on a salary, a hospital can charge higher rates, which the parties then split.

Furthermore, the mergers are shifting power from physicians and other caregivers to administrators and corporations, “whose loyalty lies with the institutions or shareholders.” Alternately, the authors contend, the emphasis in healthcare should be placed on the formation of physician groups; specifically, multispecialty group practices, including nurses and other midlevel providers, that work together to coordinate care.

The best solution, the authors believe, is to build organizations such as Accountable Care Organizations controlled by primary-care physicians. One way to do this would be for Medicare to expand its “Advance Payment Model,” a program that provides capital to small and rural physician groups. Experiments with incentives for models like this could potentially accelerate the formation of multispecialty ACOs driven by primary care. In the end, we need to “give primary-care groups control over what happens to patients, large hospital systems, and specialist-dominated groups” so that those with the greatest access to capital do not keep raising prices.

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