(ACO) regulations - American Society of Anesthesiologists

More documents

Recommendations

Info

CMS-1345-P 272 and additional increases for including FQHCs and/or RHCs) would be applied to net savings above this 2 percent threshold in order to determine the shared savings amount. We believe that this threshold protects the program from sharing unearned savings and helps to ensure that shared savings are due to enhanced care coordination and quality of care on the part of the ACO. As previously discussed, many smaller physician-driven ACOs and ACOs caring for underserved populations have the potential to improve the quality and efficiency of care, but may be especially challenged in accessing capital to meet their needs. We hope to encourage successful participation by these ACOs in the Shared Savings Program. Additionally, we acknowledge that providers/suppliers working in these environments face additional challenges in coordinating care and creating the infrastructure necessary to create a successful ACO, and therefore may not be equipped to assume the risk right away (and be eligible for greater reward) of the two-sided model. As such, we are proposing that ACOs that meet the following criteria would be exempt from the 2 percent net savings threshold and would instead share on first dollar savings under the one-sided model. We propose to exempt ACOs with less than 10,000 assigned beneficiaries in the most recent year for which we have complete claims data (for instance, 2012 for 2014 program participation) and that meet one of the following: • The ACO is comprised only of ACO professionals in group practice arrangements or networks of individual practices of ACO professionals. • 75 percent or more of the ACO's assigned beneficiaries reside in counties outside a Metropolitan Statistical Area (MSA) in the most recent year for which we have complete claims data.
CMS-1345-P 273 • 50 percent or more of the ACO's assigned beneficiaries were assigned to the ACO on the basis of primary care services received from a Method II CAH. • 50 percent or more of the beneficiaries assigned to the ACO had at least one encounter with an ACO participant FQHC and/or RHC in the most recent year for which we have complete claims data, that is, the ACO has met criteria for receiving full potential additional payment as described later in this proposed rule. We invite comment on these proposals and the other options considered. 12. Additional Shared Savings Payments for Including FQHCs and/or RHCs We are also proposing that an ACO in the one-sided model can receive an increase in its shared savings rate of up to 2.5 percentage points during the first 2 years of its agreement, for including a strong FQHC and/or RHC presence within the structure of the ACO. (See section II.G. of this proposed rule for details surrounding the two-sided model which provides for a 5 percentage point increase for including FQHCs or RHCs or both.) FQHCs and RHCs have long delivered comprehensive, high-quality primary health care to patients regardless of their ability to pay, and increase access to health care through innovative models of community-based, comprehensive primary health care that focus on outreach, disease prevention, and patient education activities. FQHCs provide high-quality care to rural and urban populations alike by focusing attention on improving public health through preventive care in addition to direct patient care. Not only do health centers provide critical, high quality primary care in the Nation's neediest areas, but reports have shown that the health center model of care can reduce the use of costlier providers of care, such as emergency departments and hospitals. Currently, more than
Page 1 and 2:
DEPARTMENT OF HEALTH AND HUMAN SERV
Page 3 and 4:
CMS-1345-P 3 Centers for Medicare &
Page 5 and 6:
CMS-1345-P 5 C. Overview and Intent
Page 7 and 8:
CMS-1345-P 7 7. Aligning ACO Qualit
Page 9 and 10:
CMS-1345-P 9 CCNC Community Care of
Page 11 and 12:
CMS-1345-P 11 SSN TIN Social Securi
Page 13 and 14:
CMS-1345-P 13 better coordinate car
Page 15 and 16:
CMS-1345-P 15 and efficient service
Page 17 and 18:
CMS-1345-P 17 ACO shall have at lea
Page 19 and 20:
CMS-1345-P 19 program or demonstrat
Page 21 and 22:
CMS-1345-P 21 Section 1899(d)(3) of
Page 23 and 24:
CMS-1345-P 23 Section 1899 (i) of t
Page 25 and 26:
CMS-1345-P 25 • An ACO will manag
Page 27 and 28:
CMS-1345-P 27 providers participati
Page 29 and 30:
CMS-1345-P 29 The Affordable Care A
Page 31 and 32:
CMS-1345-P 31 establish an estimate
Page 33 and 34:
CMS-1345-P 33 personal physicians;
Page 35 and 36:
CMS-1345-P 35 • Experience with n
Page 37 and 38:
CMS-1345-P 37 when looking at the e
Page 39 and 40:
CMS-1345-P 39 Medicare FFS benefici
Page 41 and 42:
CMS-1345-P 41 by only those ACO par
Page 43 and 44:
CMS-1345-P 43 Since the statute req
Page 45 and 46:
CMS-1345-P 45 For FQHCs and RHCs, t
Page 47 and 48:
CMS-1345-P 47 individual practition
Page 49 and 50:
CMS-1345-P 49 additional Medicare e
Page 51 and 52:
CMS-1345-P 51 The ACO's legal entit
Page 53 and 54:
CMS-1345-P 53 We note that by propo
Page 55 and 56:
CMS-1345-P 55 and administrative sy
Page 57 and 58:
CMS-1345-P 57 governance would crea
Page 59 and 60:
CMS-1345-P 59 demonstration, partic
Page 61 and 62:
CMS-1345-P 61 We believe that these
Page 63 and 64:
CMS-1345-P 63 • Clinical manageme
Page 65 and 66:
CMS-1345-P 65 participants and ACO
Page 67 and 68:
CMS-1345-P 67 Section 1899(b)(2)(A)
Page 69 and 70:
CMS-1345-P 69 be subject to the req
Page 71 and 72:
CMS-1345-P 71 program while still f
Page 73 and 74:
CMS-1345-P 73 Thus, we considered w
Page 75 and 76:
CMS-1345-P 75 addressing situations
Page 77 and 78:
CMS-1345-P 77 include provisions fo
Page 79 and 80:
CMS-1345-P 79 b. Processes to Promo
Page 81 and 82:
CMS-1345-P 81 • Telehealth. • T
Page 83 and 84:
CMS-1345-P 83 centeredness that is
Page 85 and 86:
CMS-1345-P 85 mechanism for coordin
Page 87 and 88:
CMS-1345-P 87 We are soliciting com
Page 89 and 90:
CMS-1345-P 89 to ensure that survey
Page 91 and 92:
CMS-1345-P 91 panel. Such a proposa
Page 93 and 94:
CMS-1345-P 93 addressing disparitie
Page 95 and 96:
CMS-1345-P 95 Individualized plans
Page 97 and 98:
CMS-1345-P 97 beneficiaries by mini
Page 99 and 100:
CMS-1345-P 99 a. Compliance Plans W
Page 101 and 102:
CMS-1345-P 101 generated by ACO par
Page 103 and 104:
CMS-1345-P 103 C. Establishing the
Page 105 and 106:
CMS-1345-P 105 After evaluating the
Page 107 and 108:
CMS-1345-P 107 when the final payme
Page 109 and 110:
CMS-1345-P 109 performance of ACO p
Page 111 and 112:
CMS-1345-P 111 cost-effectiveness o
Page 113 and 114:
CMS-1345-P 113 they identify priori
Page 115 and 116:
CMS-1345-P 115 generally bars the d
Page 117 and 118:
CMS-1345-P 117 acting on behalf of
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
Page 135 and 136:
CMS-1345-P 135 ensure that ACOs und
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
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 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
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 191 and 192:
Page 193 and 194:
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
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
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
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
Page 235 and 236: CMS-1345-P 235 determinations about
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
Page 247 and 248: CMS-1345-P 247 other factor could b
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
Page 257 and 258: CMS-1345-P 257 subsequently receive
Page 259 and 260: CMS-1345-P 259 This benchmark is su
Page 261 and 262: CMS-1345-P 261 nationwide under the
Page 263 and 264: CMS-1345-P 263 benchmark based on t
Page 265 and 266: CMS-1345-P 265 upon the number of M
Page 267 and 268: CMS-1345-P 267 beneficiaries. In re
Page 269 and 270: CMS-1345-P 269 and share in savings
Page 271: CMS-1345-P 271 a result of normal y
Page 275 and 276: CMS-1345-P 275 • Among older adul
Page 277 and 278: CMS-1345-P 277 of dual eligible ben
Page 279 and 280: CMS-1345-P 279 they incur shareable
Page 281 and 282: CMS-1345-P 281 for the Medicare pro
Page 283 and 284: CMS-1345-P 283 and efficiency of ca
Page 285 and 286: CMS-1345-P 285 have also suggested
Page 287 and 288: CMS-1345-P 287 providers' willingne
Page 289 and 290: CMS-1345-P 289 expect to consider i
Page 291 and 292: CMS-1345-P 291 two years under the
Page 293 and 294: CMS-1345-P 293 Design Element Minim
Page 295 and 296: CMS-1345-P 295 performance) under t
Page 297 and 298: CMS-1345-P 297 For purposes of the
Page 299 and 300: CMS-1345-P 299 proposed that for th
Page 301 and 302: CMS-1345-P 301 For example, a two-s
Page 303 and 304: CMS-1345-P 303 depends on the ACO's
Page 305 and 306: CMS-1345-P 305 have solicited comme
Page 307 and 308: CMS-1345-P 307 the ACO's repayment
Page 309 and 310: CMS-1345-P 309 the growth in Medica
Page 311 and 312: CMS-1345-P 311 relied upon by us in
Page 313 and 314: CMS-1345-P 313 requirements not set
Page 315 and 316: CMS-1345-P 315 entity is in an arra
Page 317 and 318: CMS-1345-P 317 disease) or benefici
Page 319 and 320: CMS-1345-P 319 information. If the
Page 321 and 322: CMS-1345-P 321 ● Failure to compl
Page 323 and 324:
CMS-1345-P 323 harm to beneficiarie
Page 325 and 326:
CMS-1345-P 325 determinations would
Page 327 and 328:
CMS-1345-P 327 Shared Savings Progr
Page 329 and 330:
CMS-1345-P 329 CMS and OIG have joi
Page 331 and 332:
CMS-1345-P 331 The Antitrust Policy
Page 333 and 334:
CMS-1345-P 333 previously. Such an
Page 335 and 336:
CMS-1345-P 335 protects beneficiary
Page 337 and 338:
CMS-1345-P 337 both Medicare benefi
Page 339 and 340:
CMS-1345-P 339 J. Overlap with Othe
Page 341 and 342:
CMS-1345-P 341 CMS shared savings p
Page 343 and 344:
CMS-1345-P 343 Shared Savings Progr
Page 345 and 346:
CMS-1345-P 345 improve the Shared S
Page 347 and 348:
CMS-1345-P 347 V. Regulatory Impact
Page 349 and 350:
CMS-1345-P 349 The Shared Savings P
Page 351 and 352:
CMS-1345-P 351 ACOs work to improve
Page 353 and 354:
CMS-1345-P 353 presumably provide a
Page 355 and 356:
CMS-1345-P 355 • Number of partic
Page 357 and 358:
CMS-1345-P 357 distribution. With t
Page 359 and 360:
CMS-1345-P 359 c. Further Considera
Page 361 and 362:
CMS-1345-P 361 More specifically, w
Page 363 and 364:
CMS-1345-P 363 program and uncertai
Page 365 and 366:
CMS-1345-P 365 Savings Program at 7
Page 367 and 368:
CMS-1345-P 367 ACO-attributed claim
Page 369 and 370:
CMS-1345-P 369 Category Costs COSTS
Page 371 and 372:
CMS-1345-P 371 For the reasons set
Page 373 and 374:
CMS-1345-P 373 (2) Program requirem
Page 375 and 376:
CMS-1345-P 375 Act. Hospital means
Page 377 and 378:
CMS-1345-P 377 meet the minimum qua
Page 379 and 380:
CMS-1345-P 379 (C) Begin to operate
Page 381 and 382:
CMS-1345-P 381 (D) The civil moneta
Page 383 and 384:
CMS-1345-P 383 prior to the start o
Page 385 and 386:
CMS-1345-P 385 for populations, and
Page 387 and 388:
CMS-1345-P 387 monitoring and evalu
Page 389 and 390:
CMS-1345-P 389 (i) It plans to use
Page 391 and 392:
CMS-1345-P 391 (1) Have a beneficia
Page 393 and 394:
CMS-1345-P 393 who were an ACO part
Page 395 and 396:
CMS-1345-P 395 amount for the patie
Page 397 and 398:
CMS-1345-P 397 under §425.7(b). An
Page 399 and 400:
CMS-1345-P 399 (ii) To be responsib
Page 401 and 402:
CMS-1345-P 401 §425.8 ACO quality
Page 403 and 404:
CMS-1345-P 403 (2) CMS scores indiv
Page 405 and 406:
CMS-1345-P 405 (a) Monitoring of AC
Page 407 and 408:
CMS-1345-P 407 required measure dat
Page 409 and 410:
CMS-1345-P 409 (5) The procedures e
Page 411 and 412:
CMS-1345-P 411 demonstrate in its a
Page 413 and 414:
CMS-1345-P 413 days of the notice o
Page 415 and 416:
CMS-1345-P 415 original notice of d
Page 417 and 418:
CMS-1345-P 417 (c) Notwithstanding
Page 419 and 420:
CMS-1345-P 419 (ii) Quality perform
Page 421 and 422:
CMS-1345-P 421 (i) The beneficiary
Page 423 and 424:
CMS-1345-P 423 terminated from the
Page 425 and 426:
CMS-1345-P 425 inclusion of additio
Page 427 and 428:
CMS-1345-P 427 individuals, better
Page 429:
CMS-1345-P 04/07/2011] [FR Doc. 201
show all

(ACO) regulations - American Society of Anesthesiologists

Create successful ePaper yourself

Delete template?

Save as template?