(ACO) regulations - American Society of Anesthesiologists

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CMS-1345-P 70 comment on our proposal to make shared savings payments to a non-Medicare-enrolled entity. While section 1899(b)(2)(C) of the Act requires an ACO to have a formal legal structure that would allow the organization to receive and distribute payments for shared savings to participating providers of services and suppliers, the statute does not establish any requirements for the manner in which shared savings payments are distributed. We have considered whether it would be appropriate, under the broad discretion granted to the Secretary in implementing the Shared Savings Program, to propose criteria for the distribution of shared savings by the ACO. Although we do not believe we have the authority to specify how shared savings must be distributed (so long as the distribution is consistent with all applicable legal requirements), we believe it would be consistent with the purpose and intent of the statute to require the ACO to indicate as part of its application how it plans to use potential shared savings to meet the goals of the program. More specifically, ACOs would have to indicate how potential shared savings would be used to promote accountability for their Medicare population and the coordination of their care as well as how they might be invested in infrastructure and redesigned care processes for high quality and efficient health care service delivery. Therefore, we propose to require ACOs to provide a description in their application of the criteria they plan to employ for distributing shared savings among ACO participants and ACO providers/suppliers, and how any shared savings will be used to align with the aims of better care for individuals, better health for populations, and lower growth in expenditures. We believe the proposed requirement would achieve the most appropriate balance among objectives for encouraging participation, innovation, and achievement of
CMS-1345-P 71 program while still focusing on the aims of better care for individuals, better health for populations, and lower growth in expenditures. Additionally, it is the intention of this requirement for ACOs to include this description in the application, to both guard against improper financial incentives as well as ensure appropriate beneficiary protections. 7. Sufficient Number of Primary Care Providers and Beneficiaries Section 1899(b)(2)(D) of the Act requires participating ACOs to "include primary care ACO professionals that are sufficient for the number of Medicare fee-for-service beneficiaries assigned to the ACO …" and that at a minimum, "the ACO shall have at least 5,000 such beneficiaries assigned to it …." Physician patient panels can vary widely in the number of FFS Medicare beneficiaries served. In section II. C. of this proposed rule, we discuss our proposal to assign beneficiaries to an ACO on the basis of primary care services rendered by physicians with primary care specializations in general practice, internal medicine, family practice, and geriatric medicine. We are proposing that this algorithm will also be used to assign beneficiaries during the baseline years in order to establish a historical per capita cost benchmark against which the ACO would be evaluated during each year of the agreement period. We believe it is reasonable to assume that if by using this algorithm the ACO demonstrates a sufficient number of beneficiaries to fulfill this eligibility requirement for purposes of establishing a benchmark, then the ACO also contains a sufficient number of primary care professionals to provide care to these beneficiaries. It is also reasonable to assume the ACO would continue to approximate this number in each year of the agreement period. Thus, we are proposing that for purposes of eligibility under section 1899(b)(2)(D) of the Act, an ACO would be determined to have a sufficient number of primary care ACO professionals 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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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
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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)
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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
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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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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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