(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 258
1848 of the Act for value-based purchasing initiatives such as Physician Quality
Reporting System, eRx, and the EHR incentives for eligible professionals under the
HITECH Act from the computations of both benchmark and actual expenditures during
the agreement period. We believe that excluding these costs and savings will reduce the
chances that incentives that were intended to encourage and reward participation in one
Medicare program would discourage full participation in another. We seek comments on
this proposal.
Section 1899(b)(3)(D) of the Act does not, however, provide authority for the
Secretary to exclude Medicare expenditures or savings for incentive payments and
penalties not under section 1848 of the Act from benchmark and actual expenditures.
Therefore, payments that are reflected in Part A and B claims for services furnished to
assigned FFS beneficiaries, such as EHR incentive payments to hospitals and the
Hospital Inpatient Value-Based Purchasing Program, which are made under section 1886
of the Act, and EHR incentive payments to CAHs, which are made under section 1814 of
the Act, (or any incentive payments not made under section 1848 of the Act) would be
counted in both the computation of actual expenditures and benchmark expenditures for
Part A and B costs.
8. Trending Forward Prior Years' Experience to Obtain an Initial Benchmark
Section 1899(d)(1)(B)(ii) of the Act requires the use of "the most recent 3 years of
per-beneficiary expenditures for parts A and B services" to estimate a benchmark for
each ACO. As the statute requires the use of historical expenditures, the per capita costs
for each year must be trended forward to current year dollars and then averaged using the
weights previously described to obtain the benchmark for the first agreement period.