(ACO) regulations - American Society of Anesthesiologists

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CMS-1345-P 130 also realized high patient participation rates by using an opt-in method of patient choice. 10 An opt-in method has several advantages. Consumers have consistently expressed a desire that their consent should be sought before their health information may be shared. 11 Obtaining affirmative written permission would also provide documentation of the beneficiary's choice. However, many organizations find that an opt-in approach significantly reduces both provider and beneficiary participation for administrative reasons, and not because patients are making an active choice not to participate. 12 Where opt-in rates are very high, significant paperwork burdens arise as providers must track consents for the majority of their patient population. Reducing such burdens is one of the major reasons that other organizations engaged in health information exchange have adopted an opt-out approach. 12,13 An opt-out approach is used successfully in most systems of electronic exchange of information 13 because it is significantly less burdensome on consumers and providers while still providing an opportunity for caregivers to engage with patients to 10 J. Shapiro, J. Bartley, G. Kuperman, Health Information Exchange Consent Policy Influences: Emergency Department Patient Data Accessibility. ACEP 2010. See also N. Daurio, et al. Implementation of an Enterprise-wide Electronic Health Record: A Nurse-Physician Partnership, in K. Saranto et al., eds, Connecting Health and Humans (IOS Press 2009). 11 Schneider, at 36-37. Public Attitudes Toward Medical Privacy. (2000). Conducted by The Gallup Organization on behalf of the Institute for Health Freedom. Available at: http://forhealthfreedom.org/Gallupsurvey/IHF-Gallup.html. 12 See Micky Tripathi, David Delano, Barbara Lund and Lynda Rudolph. "Engaging Patients for Health Information Exchange." Health Affairs. Volume 28, Number 2. March/April 2009; Missouri Office of Health Information Technology. Opt-in Versus Opt-out: Consent Models for Health Information Exchange through Missouri's Statewide Health Information Exchange Network. Jefferson City: Missouri. Department of Social Services (2010). Available online at http://www.dss.mo.gov/hie/leadership/pdf2010/optin_vs_optout_overview.pdf. 12 See Goldstein, M.M. and A.L. Rein. Consumer Consent Options for Electronic Health Information Exchange: Policy Considerations and Analysis," March, 2010, at 35. Available at: http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_911197_0_0_18/ChoiceModelFinal032 610.pdf 13 See Goldstein, M.M. and A.L. Rein. Consumer Consent Options for Electronic Health Information Exchange: Policy Considerations and Analysis," March, 2010, at 35. Available at: http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_911197_0_0_18/ChoiceModelFinal032 610.pdf.
CMS-1345-P 131 promote trust and permitting patients to exercise control over their data. We are concerned about the effect of an opt-in approach on beneficiary participation and the additional administrative burdens on physician practices. Therefore, we propose affording beneficiaries the ability to opt-out of sharing their protected health information with the ACO. We believe this opportunity coupled with notification of how protected health information will be shared and used affords beneficiaries meaningful choice. An example of the opt-out approach would be that when a beneficiary has a visit with their primary care physician, their physician would inform them at this visit that he or she is an ACO participant or ACO provider/supplier and that the ACO would like to be able to request claims information from us in order to better coordinate the beneficiary's care. If the beneficiary objects, we propose that the beneficiary would be given a form stating that they have been informed of their physician's participation in the ACO and explaining how to opt-out of having their personal data shared. The form could include a phone number and/or email address for beneficiaries to call and request that their data not be shared. As discussed in section II. D., the Shared Savings Program lays the foundation for a beneficiary-centered delivery system that should create a new relationship between beneficiaries and care providers based, in large part, on patient engagement in the new care system. The successful creation of this relationship is not possible when beneficiaries are not aware of the new delivery system available through ACOs, and the possibility of being included in the population assigned to an ACO. We therefore propose to develop a communications plan, discussed in more detail in section II. D of this proposed rule, that will offer insight into both the Shared Savings Program in general and the beneficiaries' right to opt-out of the data sharing portion of
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DEPARTMENT OF HEALTH AND HUMAN SERV
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CMS-1345-P 3 Centers for Medicare &
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CMS-1345-P 5 C. Overview and Intent
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CMS-1345-P 7 7. Aligning ACO Qualit
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CMS-1345-P 9 CCNC Community Care of
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CMS-1345-P 11 SSN TIN Social Securi
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CMS-1345-P 13 better coordinate car
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CMS-1345-P 15 and efficient service
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CMS-1345-P 17 ACO shall have at lea
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CMS-1345-P 19 program or demonstrat
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CMS-1345-P 21 Section 1899(d)(3) of
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CMS-1345-P 23 Section 1899 (i) of t
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CMS-1345-P 25 • An ACO will manag
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CMS-1345-P 27 providers participati
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CMS-1345-P 29 The Affordable Care A
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CMS-1345-P 31 establish an estimate
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CMS-1345-P 33 personal physicians;
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CMS-1345-P 35 • Experience with n
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CMS-1345-P 37 when looking at the e
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CMS-1345-P 39 Medicare FFS benefici
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CMS-1345-P 41 by only those ACO par
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CMS-1345-P 43 Since the statute req
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CMS-1345-P 45 For FQHCs and RHCs, t
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CMS-1345-P 47 individual practition
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CMS-1345-P 49 additional Medicare e
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CMS-1345-P 51 The ACO's legal entit
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CMS-1345-P 53 We note that by propo
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CMS-1345-P 55 and administrative sy
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CMS-1345-P 57 governance would crea
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CMS-1345-P 59 demonstration, partic
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CMS-1345-P 61 We believe that these
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CMS-1345-P 63 • Clinical manageme
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CMS-1345-P 65 participants and ACO
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CMS-1345-P 67 Section 1899(b)(2)(A)
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CMS-1345-P 69 be subject to the req
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CMS-1345-P 71 program while still f
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CMS-1345-P 73 Thus, we considered w
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CMS-1345-P 75 addressing situations
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CMS-1345-P 77 include provisions fo
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Page 81 and 82: CMS-1345-P 81 • Telehealth. • T
Page 83 and 84: CMS-1345-P 83 centeredness that is
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Page 87 and 88: CMS-1345-P 87 We are soliciting com
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Page 91 and 92: CMS-1345-P 91 panel. Such a proposa
Page 93 and 94: CMS-1345-P 93 addressing disparitie
Page 95 and 96: CMS-1345-P 95 Individualized plans
Page 97 and 98: CMS-1345-P 97 beneficiaries by mini
Page 99 and 100: CMS-1345-P 99 a. Compliance Plans W
Page 101 and 102: CMS-1345-P 101 generated by ACO par
Page 103 and 104: CMS-1345-P 103 C. Establishing the
Page 105 and 106: CMS-1345-P 105 After evaluating the
Page 107 and 108: CMS-1345-P 107 when the final payme
Page 109 and 110: CMS-1345-P 109 performance of ACO p
Page 111 and 112: CMS-1345-P 111 cost-effectiveness o
Page 113 and 114: CMS-1345-P 113 they identify priori
Page 115 and 116: CMS-1345-P 115 generally bars the d
Page 117 and 118: CMS-1345-P 117 acting on behalf of
Page 119 and 120: CMS-1345-P 119 previous year's hist
Page 121 and 122: CMS-1345-P 121 providers/suppliers.
Page 123 and 124: CMS-1345-P 123 permitted under the
Page 125 and 126: CMS-1345-P 125 and the claim paymen
Page 127 and 128: CMS-1345-P 127 measurement activiti
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Page 133 and 134: CMS-1345-P 133 beneficiaries. We an
Page 135 and 136: CMS-1345-P 135 ensure that ACOs und
Page 137 and 138: CMS-1345-P 137 eligibility since th
Page 139 and 140: CMS-1345-P 139 or to providers or s
Page 141 and 142: CMS-1345-P 141 ACO and the eligibil
Page 143 and 144: CMS-1345-P 143 From a technical, op
Page 145 and 146: CMS-1345-P 145 beneficiaries would
Page 147 and 148: CMS-1345-P 147 associated with thos
Page 149 and 150: CMS-1345-P 149 pediatric medicine,"
Page 151 and 152: CMS-1345-P 151 care services" on th
Page 153 and 154: CMS-1345-P 153 better address the d
Page 155 and 156: CMS-1345-P 155 assignment from year
Page 157 and 158: CMS-1345-P 157 appropriate safeguar
Page 159 and 160: CMS-1345-P 159 ACO only when he or
Page 161 and 162: CMS-1345-P 161 We propose to implem
Page 163 and 164: CMS-1345-P 163 quality and shared s
Page 165 and 166: CMS-1345-P 165 chosen. We seek comm
Page 167 and 168: CMS-1345-P 167 measures to assess t
Page 169 and 170: CMS-1345-P 169 • To the extent pr
Page 171 and 172: CMS-1345-P 171 data collection and
Page 173 and 174: CMS-1345-P 173 improving ACO qualit
Page 175 and 176: CMS-1345-P 175 Domain Measure Title
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CMS-1345-P 181 Domain Measure Title
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CMS-1345-P 187 43. At Risk Populati
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CMS-1345-P 189 50. At Risk Populati
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CMS-1345-P 195 Information on Physi
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CMS-1345-P 197 associated with clai
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CMS-1345-P 199 be required to popul
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CMS-1345-P 201 as that term is defi
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CMS-1345-P 203 Table 2: Five Measur
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CMS-1345-P 205 sided shared savings
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CMS-1345-P 207 Table 4: Total Point
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CMS-1345-P 209 Medicare program. Fu
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CMS-1345-P 211 for the first perfor
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CMS-1345-P 213 of quality acknowled
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CMS-1345-P 215 (Option 1) but using
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CMS-1345-P 217 ACO would qualify fo
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CMS-1345-P 219 future rulemaking. W
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CMS-1345-P 221 proposing greater al
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CMS-1345-P 223 6. Public Reporting
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CMS-1345-P 225 efficiency, effectiv
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CMS-1345-P 227 this information ava
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CMS-1345-P 229 Specifically, we see
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CMS-1345-P 231 We considered severa
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CMS-1345-P 233 Track 2: More experi
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CMS-1345-P 235 determinations about
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CMS-1345-P 237 beneficiaries during
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CMS-1345-P 239 truncate an assigned
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CMS-1345-P 241 the demonstration wh
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CMS-1345-P 243 We seek comments abo
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CMS-1345-P 245 Of these two methods
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CMS-1345-P 247 other factor could b
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CMS-1345-P 249 Capitation Rates, Pa
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CMS-1345-P 251 A model that uses be
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CMS-1345-P 253 option to audit ACOs
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CMS-1345-P 255 Thus, we are not pro
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CMS-1345-P 257 subsequently receive
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CMS-1345-P 259 This benchmark is su
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CMS-1345-P 261 nationwide under the
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CMS-1345-P 263 benchmark based on t
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CMS-1345-P 265 upon the number of M
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CMS-1345-P 267 beneficiaries. In re
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CMS-1345-P 269 and share in savings
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CMS-1345-P 271 a result of normal y
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CMS-1345-P 273 • 50 percent or mo
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CMS-1345-P 275 • Among older adul
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CMS-1345-P 277 of dual eligible ben
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CMS-1345-P 279 they incur shareable
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CMS-1345-P 281 for the Medicare pro
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CMS-1345-P 283 and efficiency of ca
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CMS-1345-P 285 have also suggested
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CMS-1345-P 287 providers' willingne
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CMS-1345-P 289 expect to consider i
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CMS-1345-P 291 two years under the
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CMS-1345-P 293 Design Element Minim
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CMS-1345-P 295 performance) under t
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CMS-1345-P 297 For purposes of the
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CMS-1345-P 299 proposed that for th
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CMS-1345-P 301 For example, a two-s
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CMS-1345-P 303 depends on the ACO's
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CMS-1345-P 305 have solicited comme
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CMS-1345-P 307 the ACO's repayment
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CMS-1345-P 309 the growth in Medica
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CMS-1345-P 311 relied upon by us in
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CMS-1345-P 313 requirements not set
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CMS-1345-P 315 entity is in an arra
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CMS-1345-P 317 disease) or benefici
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CMS-1345-P 319 information. If the
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CMS-1345-P 321 ● Failure to compl
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CMS-1345-P 323 harm to beneficiarie
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CMS-1345-P 325 determinations would
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CMS-1345-P 327 Shared Savings Progr
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CMS-1345-P 329 CMS and OIG have joi
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CMS-1345-P 331 The Antitrust Policy
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CMS-1345-P 333 previously. Such an
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CMS-1345-P 335 protects beneficiary
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CMS-1345-P 337 both Medicare benefi
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CMS-1345-P 339 J. Overlap with Othe
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CMS-1345-P 341 CMS shared savings p
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CMS-1345-P 343 Shared Savings Progr
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CMS-1345-P 345 improve the Shared S
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CMS-1345-P 347 V. Regulatory Impact
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CMS-1345-P 349 The Shared Savings P
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CMS-1345-P 351 ACOs work to improve
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CMS-1345-P 353 presumably provide a
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CMS-1345-P 355 • Number of partic
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CMS-1345-P 357 distribution. With t
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CMS-1345-P 359 c. Further Considera
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CMS-1345-P 361 More specifically, w
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CMS-1345-P 363 program and uncertai
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CMS-1345-P 365 Savings Program at 7
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CMS-1345-P 367 ACO-attributed claim
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CMS-1345-P 369 Category Costs COSTS
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CMS-1345-P 371 For the reasons set
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CMS-1345-P 373 (2) Program requirem
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CMS-1345-P 375 Act. Hospital means
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CMS-1345-P 377 meet the minimum qua
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CMS-1345-P 379 (C) Begin to operate
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CMS-1345-P 381 (D) The civil moneta
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CMS-1345-P 383 prior to the start o
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CMS-1345-P 385 for populations, and
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CMS-1345-P 387 monitoring and evalu
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CMS-1345-P 389 (i) It plans to use
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CMS-1345-P 391 (1) Have a beneficia
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CMS-1345-P 393 who were an ACO part
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CMS-1345-P 395 amount for the patie
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CMS-1345-P 397 under §425.7(b). An
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CMS-1345-P 399 (ii) To be responsib
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CMS-1345-P 401 §425.8 ACO quality
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CMS-1345-P 403 (2) CMS scores indiv
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CMS-1345-P 405 (a) Monitoring of AC
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CMS-1345-P 407 required measure dat
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CMS-1345-P 409 (5) The procedures e
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CMS-1345-P 411 demonstrate in its a
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CMS-1345-P 413 days of the notice o
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CMS-1345-P 415 original notice of d
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CMS-1345-P 417 (c) Notwithstanding
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CMS-1345-P 419 (ii) Quality perform
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CMS-1345-P 421 (i) The beneficiary
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CMS-1345-P 423 terminated from the
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CMS-1345-P 425 inclusion of additio
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CMS-1345-P 427 individuals, better
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CMS-1345-P 04/07/2011] [FR Doc. 201
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