(ACO) regulations - American Society of Anesthesiologists

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CMS-1345-P 208 previously, we propose calculating the percentage of points an ACO earns for each domain by dividing the points earned by the total points available, yielding a percentage. For example, if an ACO earns 16.2 out of 18 points in the preventive health domain, the ACO earned 90 percent of the points for the preventive health domain (16.2 divided by 18 equals .90). Assuming the ACO is operating under the two-sided shared savings model and earns 90 percent of the quality performance points across all five domains and generates shared savings, it would receive 90 percent of the ACO's share of the savings or 54 percent of the total savings generated. That is, achieving 90 percent of the potential 60 percent of shared savings an ACO can earn under the two-sided model, means the ACO could earn 54 percent of the total savings generated. Under the one-sided model, achieving 90 percent of the potential 50 percent of shared savings, means the ACO could earn 45 percent of the shareable savings generated. Under both the one-sided and two-sided shared savings models, the quality measures domain scoring methodology treats all domains equally regardless of the number of measures within the domain. We believe the key benefit of weighting the domains equally is that it does not create a preference for any one domain, which we believe is important as we expect ACOs to vary in composition, and, as a result, to place more emphasis on different domains. We also considered weighting the domains to emphasize priority conditions or areas in order to emphasize (or de-emphasize) certain measures that are more difficult (or easy) to achieve without needing to change the scoring methodology. This method would require judgment about which domains are more important than others, which may not be appropriate. Equal weighting contains an implicit judgment that domains such as patient/caregiver experience of care and patient safety are equally important to the quality of care. Accordingly, we believe ACOs should seek to address all aspects of patient care in order to improve the overall quality of care under the
CMS-1345-P 209 Medicare program. Furthermore, we want to encourage a diverse set of ACOs and believe that emphasizing certain domains over others would encourage a certain type of ACO to participate but discourage other types from participating. We propose aggregating the quality domain scores into a single overall ACO score which would be used to calculate the ACOs final sharing rate for purposes of determining shared savings or shared losses as described in section II.F. of this proposed rule. All domain scores for an ACO would be averaged together equally to calculate the overall quality score that would be used to calculated the ACO's final sharing rate. We also propose that ACOs must report completely and accurately on all measures within all domains to be deemed eligible for shared savings consideration. We believe this is important as it requires ACOs to address all domains and be accountable across the continuum of care. If the ACO demonstrates sufficient cost savings in addition to meeting the quality performance requirements, the ACO would be deemed eligible for shared savings. We believe that this methodology provides a sufficient incentive for quality improvement targeted to specific domains and allows ACOs of varying compositions, which may be stronger in some domains than others, to receive some level of shared savings. In addition to this proposed domain-based scoring methodology, we considered several other options for assessing the quality performance of ACOs. We considered scoring measures individually under a method that would weight all measures equally. Each measure would be worth the maximum points available as described previously for a total maximum possible points for each ACO. This system would avoid overweighting or underweighting measures due to the number of measures in a domain. We also considered weighting quality measures by their clinical importance. More important quality measures would account for a greater proportion of shared savings. Outcome measures such as
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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
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CMS-1345-P 121 providers/suppliers.
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CMS-1345-P 123 permitted under the
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CMS-1345-P 125 and the claim paymen
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CMS-1345-P 127 measurement activiti
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CMS-1345-P 129 beneficiary choice:
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CMS-1345-P 131 promote trust and pe
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CMS-1345-P 133 beneficiaries. We an
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CMS-1345-P 135 ensure that ACOs und
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CMS-1345-P 137 eligibility since th
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CMS-1345-P 139 or to providers or s
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CMS-1345-P 141 ACO and the eligibil
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CMS-1345-P 143 From a technical, op
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CMS-1345-P 145 beneficiaries would
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CMS-1345-P 147 associated with thos
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CMS-1345-P 149 pediatric medicine,"
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CMS-1345-P 151 care services" on th
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CMS-1345-P 153 better address the d
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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
Page 187 and 188: CMS-1345-P 187 43. At Risk Populati
Page 189 and 190: CMS-1345-P 189 50. At Risk Populati
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Page 197 and 198: CMS-1345-P 197 associated with clai
Page 199 and 200: CMS-1345-P 199 be required to popul
Page 201 and 202: CMS-1345-P 201 as that term is defi
Page 203 and 204: CMS-1345-P 203 Table 2: Five Measur
Page 205 and 206: CMS-1345-P 205 sided shared savings
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Page 213 and 214: CMS-1345-P 213 of quality acknowled
Page 215 and 216: CMS-1345-P 215 (Option 1) but using
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Page 219 and 220: CMS-1345-P 219 future rulemaking. W
Page 221 and 222: CMS-1345-P 221 proposing greater al
Page 223 and 224: CMS-1345-P 223 6. Public Reporting
Page 225 and 226: CMS-1345-P 225 efficiency, effectiv
Page 227 and 228: CMS-1345-P 227 this information ava
Page 229 and 230: CMS-1345-P 229 Specifically, we see
Page 231 and 232: CMS-1345-P 231 We considered severa
Page 233 and 234: CMS-1345-P 233 Track 2: More experi
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Page 237 and 238: CMS-1345-P 237 beneficiaries during
Page 239 and 240: CMS-1345-P 239 truncate an assigned
Page 241 and 242: CMS-1345-P 241 the demonstration wh
Page 243 and 244: CMS-1345-P 243 We seek comments abo
Page 245 and 246: CMS-1345-P 245 Of these two methods
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Page 249 and 250: CMS-1345-P 249 Capitation Rates, Pa
Page 251 and 252: CMS-1345-P 251 A model that uses be
Page 253 and 254: CMS-1345-P 253 option to audit ACOs
Page 255 and 256: CMS-1345-P 255 Thus, we are not pro
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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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