(ACO) regulations - American Society of Anesthesiologists

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CMS-1345-P 220 "meaningful users" of certified EHR technology, as defined in our regulations, and the percentage of those professionals that meet the criteria for the eRx incentive, as measures that are part of the quality performance standard. These measures would be subject to the same points scale and 30 percent or 30 th percentile minimum attainment level previously described in table D3. We note that including metrics based on EHR Incentive Program and eRx Incentive Program data does not in any way duplicate or replace specific program measures within each of the two respective programs or allow eligible professionals to satisfy the requirements of either of the two programs through the Shared Savings Program. To receive incentive payments under the EHR incentive or eRx programs (or to avoid payment adjustments), eligible professionals will be required to meet all the requirements of the respective EHR and eRx programs. In addition, as a Shared Savings Program requirement separate from the quality measures reporting discussed previously, we propose requiring that at least 50 percent of an ACO's primary care physicians are determined to be "meaningful EHR users" as that term is defined in 42 CFR 495.4 as defined in the HITECH Act and subsequent Medicare regulations by the start of the second performance year in order to continue participation in the Shared Savings Program. The EHR Incentive regulations, including the definition of meaningful EHR user and certified EHR technology can be found at 42 CFR Part 495, as published on July 28, 2010 (75 FR 44314). The preamble to the July 28, 2010 final rule also describes the stages of meaningful use. We believe these approaches would foster incentives for improving and delivering high quality care by engaging providers in performance based quality incentive programs; and encourage adoption of EHRs. The requirement that at least 50 percent of ACO primary care physicians be meaningful users represents a first step towards achieving our objective of incenting full participation of ACOs' providers in the EHR Incentive Program over time. For subsequent years, we anticipate
CMS-1345-P 221 proposing greater alignment between the Shared Savings Program and the EHR Incentive program through future rulemaking. We considered several other options for incorporating other program reporting requirements into the Shared Savings Program. One option was to incorporate Physician Quality Reporting System into the Shared Savings Program via a scaled approach, in which how the ACO performs on the quality measures under the Shared Savings Program would determine the amount of Physician Quality Reporting System incentive an ACO could earn. However, we thought this approach would be burdensome and confusing to providers who are used to a different approach under the traditional Physician Quality Reporting System. We also considered proposing to limit incorporation of the Physician Quality Reporting System incentive under the Shared Savings Program to the ACO's group practices that were used for beneficiary assignment rather than to all group practices associated with an ACO. However, we thought expanding the Physician Quality Reporting System incentive under the Shared Savings Program to all participant TINs within an ACO would be more efficient for EPs participating in both traditional Physician Quality Reporting System and the Physician Quality Reporting System and the Physician Quality Reporting System incentive under the Shared Savings Program. This way ACOs would report one way for the Physician Quality Reporting System for all of its ACO providers/suppliers who are eligible professionals; that is, for purposes of qualifying for the Physician Quality Reporting System incentive, the ACO would not need to report one way for the TINs used for beneficiary assignment and another way for the TINs not used for assignment. Another option we considered was to incorporate the eRx Incentive Program's incentive requirements and payments into the Shared Savings Program. However, we are not proposing to incorporate the eRx incentive requirements and payments under the Shared Savings Program since the eRx incentive ends after 2013. We believe it would be burdensome to require ACOs to
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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
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CMS-1345-P 157 appropriate safeguar
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CMS-1345-P 159 ACO only when he or
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CMS-1345-P 161 We propose to implem
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CMS-1345-P 163 quality and shared s
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CMS-1345-P 165 chosen. We seek comm
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CMS-1345-P 167 measures to assess t
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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
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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
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Page 213 and 214: CMS-1345-P 213 of quality acknowled
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Page 217 and 218: CMS-1345-P 217 ACO would qualify fo
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Page 223 and 224: CMS-1345-P 223 6. Public Reporting
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Page 237 and 238: CMS-1345-P 237 beneficiaries during
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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
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Page 259 and 260: CMS-1345-P 259 This benchmark is su
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Page 267 and 268: CMS-1345-P 267 beneficiaries. In re
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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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