(ACO) regulations - American Society of Anesthesiologists

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CMS-1345-P 368 their clinical importance. In addition to the performance score approach that rewards ACOs for better quality with larger percentages of shared savings as modeled in this analysis, we could use a threshold approach that allows any ACO that meets minimum standards for the quality to realize the full shared savings. By design this approach could ensure higher net savings to the Medicare program, depending on the quality threshold and sharing percentage chosen. The provisions adopted in the final Shared Savings Program rule may differ from the current proposals, possibly resulting in material changes in the projected financial impact of the program. We solicit comment on other potentially effective and reasonably feasible alternatives especially those that reduce burdens and maintain flexibility and freedom of choice for the public. E. Accounting Statement and Table As required by OMB Circular A-4 (available at http://www.whitehouse.gov/sites/default/files/omb/assets/regulatory_matters_pdf/a-4.pdf), in Table 13, we have prepared an accounting statement showing the classification of transfers, benefits and costs associated with the provisions of this proposed rule. Because of the uncertainties identified in establishing the economic impact estimates, we intend to update the estimates in the final rule. TABLE 13: Accounting Statement: Estimated Transfers, Benefits and Costs (CY 2012 to CY 2014 Category Annualized Monetized Transfers From/To Category Qualitative Benefits TRANSFERS Year Dollar Units Discount Rate Notes 2011 7% 3% Primary Estimate -$167.72 million -$169.01 million 90 th Percentile Estimate -$56.19 million -$56.46 million These estimates represent the range of annualized impact on the Medicare Program for CYs 2012 - 2014. 10 th Percentile Estimate -$315.45 million -$318.02 million Federal Government to ACO Providers BENEFITS Improved healthcare delivery and communication to beneficiaries through patient centered-care.
CMS-1345-P 369 Category Costs COSTS Total ACO start-up investment and first year operating expenditures average from $131,643,825 to $263,287,650, for the estimated range of 75-150 participating ACOs. F. Conclusion As a result of this proposed rule, the median estimate of the financial impact from implementation of the Shared Savings Program, for CYs 2012 through 2014, is a net savings of $510 million. Although this is the "best estimate" for the 3-year financial impact of the Shared Savings Program initiative, a relatively wide range of possible outcomes exists. Overall, 80 percent of the stochastic trials resulted in net program savings, and the other 30 percent represented cost increases. The 10 th and 90 th percentiles of the estimate distribution show net savings of $960 million and $170 million, respectively, suggesting a 10-percent likelihood that the actual impact would exceed the respective percentile amounts. In the extreme scenarios, the results were as large as $1,960 million in savings or $270 million in costs. Lastly, the estimated aggregate cost for ACO start-up investment and first year operating expenditures in the Shared Savings Program range from $131,643,825 to $263,287,650, based on an assumed 75 to 150 ACOs participating in the Shared Savings Program. In accordance with the provisions of Executive Order 12866, this regulation was reviewed by the Office of Management and Budget.
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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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CMS-1345-P 169 • To the extent pr
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CMS-1345-P 171 data collection and
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CMS-1345-P 173 improving ACO qualit
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CMS-1345-P 175 Domain Measure Title
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CMS-1345-P 187 43. At Risk Populati
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CMS-1345-P 189 50. At Risk Populati
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CMS-1345-P 195 Information on Physi
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CMS-1345-P 197 associated with clai
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CMS-1345-P 199 be required to popul
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CMS-1345-P 201 as that term is defi
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CMS-1345-P 203 Table 2: Five Measur
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CMS-1345-P 205 sided shared savings
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CMS-1345-P 207 Table 4: Total Point
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CMS-1345-P 209 Medicare program. Fu
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CMS-1345-P 211 for the first perfor
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CMS-1345-P 213 of quality acknowled
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CMS-1345-P 215 (Option 1) but using
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CMS-1345-P 217 ACO would qualify fo
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CMS-1345-P 219 future rulemaking. W
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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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Page 321 and 322: CMS-1345-P 321 ● Failure to compl
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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
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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: CMS-1345-P 367 ACO-attributed claim
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
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Page 379 and 380: CMS-1345-P 379 (C) Begin to operate
Page 381 and 382: CMS-1345-P 381 (D) The civil moneta
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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
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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
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Page 409 and 410: CMS-1345-P 409 (5) The procedures e
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Page 417 and 418: 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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