(ACO) regulations - American Society of Anesthesiologists

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CMS-1345-P 172 to report 1 or more measures, we would send the ACO a written request to submit the required data by a specified date and to provide a reasonable written explanation for its delay in reporting the required information. If the ACO fails to report by the requested deadline and does not provide a reasonable explanation for delayed reporting, we would immediately terminate the ACO for failing to report quality measures. ACOs that exhibit a pattern of inaccurate or incomplete reporting or fail to make timely corrections following notice to resubmit may be terminated from the program. We note that since meeting the quality standard is a condition for sharing in savings, the ACO would be disqualified from sharing in savings in each year in which it underperforms. Termination from the Shared Savings Program is discussed further in sections II.H and II.C. of this proposed rule. In addition to categorizing each of the proposed measures into the goals of better care for individuals and better health for populations, Table 1 includes the domain each of the proposed measures addresses, the measure title, a brief description of the data the measure captures, applicable Physician Quality Reporting System or EHR Incentive Programs information, the measure steward or, if applicable, NQF measure number, the proposed method of data submission for each measure, and the Measure Type. Under Measure Type, we have listed Patient Experience of Care, Process, or Outcome, consistent with the domains proposed in the Hospital Value Based Purchasing rule (76 FR 2457), for each of the proposed Shared Savings Program quality measures. In an effort to provide focus to ACO quality improvement activity, we have identified 5 key domains within the dimensions of improved care and improved health that we propose will serve as the basis for assessing, benchmarking, rewarding, and
CMS-1345-P 173 improving ACO quality performance. These 5 domains are as follows: • Better Care for Individuals: ++ Patient/Caregiver Experience ++ Care Coordination ++ Patient Safety • Better Health for Populations: ++ Preventive Health ++ At-Risk Population/Frail Elderly Health We note that while many of the proposed measures have NQF endorsement or are currently used in other CMS quality programs, the specifications for some of the proposed measures will need to be refined in order to be applicable to an ACO population. However, we propose to align the quality measures specifications for the Shared Savings Program with the measures specifications used in our existing quality programs to the extent possible and appropriate for purposes of the Shared Savings Program. We plan to make the specifications for the proposed measures available on our website prior to the start of the Shared Savings Program.
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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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CMS-1345-P 117 acting on behalf of
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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
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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
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
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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
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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
Page 219 and 220: CMS-1345-P 219 future rulemaking. W
Page 221 and 222: 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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