(ACO) regulations - American Society of Anesthesiologists

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CMS-1345-P 168 services are paid for, moving increasingly toward rewarding better value, outcomes, and innovations instead of merely volume. The Shared Savings Program is a critical element of our Medicare value-based purchasing initiative. In implementing these value-based purchasing initiatives, we seek to meet certain common goals, as follows: 1. Use of Measures • Value-based payment systems and public reporting should rely on a mix of standards, processes, outcomes, and patient experience measures, including measures of care transitions and changes in patient functional status. Across all programs, we seek to move as quickly as possible to the use of outcome and patient experience measures. To the extent practicable and appropriate, these outcome and patient experience measures should be adjusted for risk or other appropriate patient population or provider characteristics. • To the extent possible, and recognizing differences in payment system maturity and statutory authorities, measures should be aligned across Medicare and Medicaid's public reporting and payment systems. We seek to evolve a focused core-set of measures appropriate to each specific provider category that reflects the level of care and the most important areas of service and measures for that provider. • The collection of information should minimize the burden on providers to the extent possible. As part of that effort, we have begun and will continuously seek to align Shared Savings Program measures with the methods and measures included in the Medicare and Medicaid EHR Incentive Programs to enable the collection and reporting of performance information to be a seamless part of care delivery and the meaningful use of certified EHR technology.
CMS-1345-P 169 • To the extent practicable, measures used by us should be nationally endorsed by a multi-stakeholder organization. Measures should be aligned with best practices among other payers and the needs of the end users of the measures. 2. Scoring Methodology • Providers should be scored on their overall achievement relative to national or other appropriate benchmarks. In addition, scoring methodologies should consider improvement as an independent goal. • Measures or measurement domains need not be given equal weight, but over time, scoring methodologies should be more weighted towards outcome, patient experience and functional status measures. • Scoring methodologies should be reliable, as straightforward as possible, and stable over time and enable consumers, providers, and payers to make meaningful distinctions among providers' performance. Consistent with these value-based purchasing principles, our principal goal in selecting quality measures for ACOs is to identify measures of success in the delivery of high-quality health care at the individual and population levels. We considered a broad array of process and outcome measures and accounted for a variety of factors in arriving at the proposed measures, prioritizing measures that meet the following: • Address the goals we previously identified: improving individual health and improving the health of populations. • Address an array of quality domains, priorities, and aims, including the IOM six quality aims previously described and the National Quality Strategy, and other HHS priorities, such as prevention, care of chronic illness, treatment of high prevalence
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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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CMS-1345-P 79 b. Processes to Promo
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CMS-1345-P 81 • Telehealth. • T
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CMS-1345-P 83 centeredness that is
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CMS-1345-P 85 mechanism for coordin
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CMS-1345-P 87 We are soliciting com
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CMS-1345-P 89 to ensure that survey
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CMS-1345-P 91 panel. Such a proposa
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CMS-1345-P 93 addressing disparitie
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CMS-1345-P 95 Individualized plans
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CMS-1345-P 97 beneficiaries by mini
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CMS-1345-P 99 a. Compliance Plans W
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CMS-1345-P 101 generated by ACO par
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CMS-1345-P 103 C. Establishing the
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CMS-1345-P 105 After evaluating the
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CMS-1345-P 107 when the final payme
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CMS-1345-P 109 performance of ACO p
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CMS-1345-P 111 cost-effectiveness o
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CMS-1345-P 113 they identify priori
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CMS-1345-P 115 generally bars the d
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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
Page 129 and 130: CMS-1345-P 129 beneficiary choice:
Page 131 and 132: CMS-1345-P 131 promote trust and pe
Page 133 and 134: CMS-1345-P 133 beneficiaries. We an
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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
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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
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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
Page 187 and 188: CMS-1345-P 187 43. At Risk Populati
Page 189 and 190: CMS-1345-P 189 50. At Risk Populati
Page 195 and 196: CMS-1345-P 195 Information on Physi
Page 197 and 198: CMS-1345-P 197 associated with clai
Page 199 and 200: CMS-1345-P 199 be required to popul
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Page 203 and 204: CMS-1345-P 203 Table 2: Five Measur
Page 205 and 206: CMS-1345-P 205 sided shared savings
Page 207 and 208: CMS-1345-P 207 Table 4: Total Point
Page 209 and 210: CMS-1345-P 209 Medicare program. Fu
Page 211 and 212: CMS-1345-P 211 for the first perfor
Page 213 and 214: CMS-1345-P 213 of quality acknowled
Page 215 and 216: CMS-1345-P 215 (Option 1) but using
Page 217 and 218: 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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(ACO) regulations - American Society of Anesthesiologists

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