The announcement comes after CMS in January launched the Pioneer Accountable Care Organization program that created 32 new ACOs, and the Physician Group Practice Transition Demonstration, which created six new ACOs (
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CMS Selects First Accountable Care Organizations in the Medicare Shared Savings Program
The Centers for Medicare and Medicaid Services (CMS) selects 27 Accountable Care Organizations (ACOs) “to participate in the Medicare Shared Savings Program,” according to a release from CMS. “All ACOs that succeed in providing high quality care – as measured by performance on 33 quality measures relating to care coordination and patient safety, use of appropriate preventive health services, improved care for at-risk populations, and the patient experience of care – while reducing the costs of care – may share in the savings to Medicare.” Additionally, “Two of the ACOs announced today applied for a version of the program that allows them to earn a higher share of any savings, in return for which they have agreed to be held accountable for a share of any losses if the costs of care for the beneficiaries assigned to them increase” and “Five of the 27 ACOs that are starting in April will participate in the Advance Payment ACO Model established by the CMS Center for Medicare and Medicaid Innovation (Innovation Center) to encourage rural and physician-based ACOs to participate in the Shared Savings Program. Under this model, each participating ACOs will receive advance payments to help cover the costs of establishing the infrastructure needed to coordinate care for the beneficiaries they serve. The advance payments will be repaid from shared savings earned by the ACO. If an ACO does not complete the full, initial agreement period of the Shared Savings Program, CMS will in most cases pursue full recoupment of advance payments.”
Physicians Leading Majority of ACOs in Medicare Shared Savings Program
This week, CMS unveiled the 27 health systems it has chosen to participate in Medicare’s Shared Savings Program as accountable care organizations (ACOs). But what’s most interesting about the announcement is not the number of ACOs that will be formed, but the type of ACOs that will be formed. “There were some people who feared that the only entities that would participate would be hospital-dominated systems,” Jonathan Blum, director of the Center for Medicare at the CMS, said in a call with reporters, according to ModernHealthcare. “That has not happened.” In fact, just over half of the health systems chosen to participate in the shared savings program — which will receive financial incentives if they manage to improve quality of patient care at reduced costs — are physician-led, according to CMS. [For more information on ACOs from a physician-perspective, read "ACOs: A Guide for Physicians."] Essentially, it appears that more and more physicians are embracing new models of care — and they are beginning to take the lead when it comes to adopting them. Not only that, larger healthcare systems and hospitals appear to be looking for physicians to take on more leadership roles. Why? As reimbursement shifts from volume of services to value of services, physicians will help determine a health system’s financial success or failure. That’s because physicians work closest with patients, they make the key treatment decisions, and as a result, they play a key role in quality and cost of care. “To be successful, healthcare organizations can no longer afford to use the ‘us’ (practitioners) against ‘them’ (administrators) paradigm,” Christine Mackey-Ross, a senior vice president of the executive search firm Witt/Kieffer, wrote in a recent article appearing in The Atlantic. “They need a combined talent approach that puts the best minds on the field, advancing quality, safety, and cost goals together.” She notes that there has already been a “major uptick” in the number of physicians who are taking on new leadership roles major healthcare systems, such as that of chief quality officer and chief clinical integration officer. In fact, according to Witt/Kieffer, 64 physician CEOs are already leading healthcare systems across the country, and many more physician executives are in the talent pipeline. Also in the pipeline? Many more physician-led ACOs. CMS is reviewing another 150 applications from additional ACOs seeking to enter the program in July. For now, the 27 ACOs just announced will serve an estimated 375,000 beneficiaries in 18 states, according to CMS. Florida and New York will each boast five ACOs; North Carolina and New Jersey, three; California, Texas, and Massachusetts, two; and Arizona, Kentucky, Georgia, Wisconsin, and New Hampshire, one. What do you think? Will new models of care like ACOs and new reimbursement trends result in more physician leadership roles? If so, how do you think that will influence the healthcare delivery system?
CMS announced today the selection of the first 27 Accountable Care Organizations
Of these 27 ACOs, 5 are participating in the Advance Payment ACO Model. This Model was established by the CMS Innovation Center to encourage rural and physician-based ACOs to participate in the Shared Savings Program. The Advance Payment ACOs receive advance payments to help cover the costs of establishing the infrastructure needed to coordinate care for the beneficiaries they serve.
27 Health Systems Selected For Shared Savings ACO Program
The Hill: More Than 1 Million Medicare Beneficiaries Enrolled In Health Law Savings Program More than one million Medicare beneficiaries are now enrolled in programs of the healthcare reform law that aim to reward doctors and hospitals for working together to improve the coordination and quality of care while saving money, the Obama administration announced Tuesday. Twenty-seven so-called “Accountable Care Organizations” have signed contracts with the Medicare agency to serve 375,000 beneficiaries in 18 states, the Medicare agency announced. The organizations are located in Arizona, California, Connecticut, Florida, Georgia, Illinois, Kentucky, Massachusetts, Mississippi, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Texas, Vermont and Wisconsin (Pecquet, 4/10).
HIT Exchange: New Affordable Care Act program to improve care, control Medicare costs, off to a strong start
A new program that will help physicians, hospitals, and other health care providers work together to improve care for people with Medicare is off to a strong start, the Centers for Medicare & Medicaid Services (CMS) announced today. Under the new Medicare Shared Savings Program (Shared Savings Program), 27 Accountable Care Organizations (ACOs) have entered into agreements with CMS, taking responsibility for the quality of care furnished to people with Medicare in return for the opportunity to share in savings realized through improved care. The Shared Savings Program and other initiatives related to Accountable Care Organizations are made possible by the Affordable Care Act, the health care law of 2010. Participation in an ACO is purely voluntary for providers and beneficiaries and people with Medicare retain their current ability to seek treatment from any provider they wish. The first 27 Shared Savings Program ACOs will serve an estimated 375,000 beneficiaries in 18 States. This brings the total number of organizations participating Medicare shared savings initiatives on April 1 to 65, including the 32 Pioneer Model ACOs that were announced last December, and six Physician Group Practice Transition Demonstration organizations that started in January 2011. In all, as of April 1, more than 1.1 million beneficiaries are receiving care from providers participating in Medicare shared savings initiatives. “We are encouraged by this strong start and confident that by the end of this year, we will have a robust program in place, benefitting millions of seniors and people with disabilities across the country,” said CMS Acting Administrator Marilyn Tavenner. Anyone who has multiple doctors may have experienced the frustration of fragmented and disconnected care: lost or unavailable medical charts, trouble scheduling an appointment or talking to a doctor, duplicated medical procedures, or having to share the same information over and over with different doctors. Accountable Care Organizations are designed to lift this burden from patients, while improving care and reducing costs. The Shared Savings Program was created by the Affordable Care Act after a number of efforts in the private sector showed that improving care can lead to lower costs. The selected ACOs include more than 10,000 physicians, 10 hospitals, and 13 smaller physician-driven organizations in both urban and rural areas. Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas they are serving. CMS is reviewing more than 150 applications from ACOs seeking to enter the program in July. To ensure that savings are achieved through improving and providing care that is appropriate, safe, and timely, an ACO must meet strict quality standards. For 2012, CMS has established 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and the patient and caregiver experience of care. CMS also announced today that five ACOs are participating in the Advance Payment ACO Model beginning April 1. This model will provide advance payment of expected shared savings to rural and physician-based ACOs participating in the Shared Savings Program that would benefit from additional start-up resources. These resources will help build the necessary care coordination infrastructure necessary to improve patient outcomes and reduce costs, such as new staff or information technology systems. CMS is reviewing more than 50 applications for Advance Payments that start in July. To learn more about the ACOs announced today, visit: http://www.cms.gov/apps/media/fact_sheets.asp For more information on the Advanced Payment ACO Model, including the participating ACOs, visit: http://innovations.cms.gov/initiatives/ACO/Advance-Payment/.
Could you be saving money?
Many people with limited income and resources may qualify for Medicare’s “Extra Help” program, but they must apply to find out. You could be one of them. You may qualify if you have up to $16,755 in yearly income ($22,695 for a married couple) and up to $13,070 in resources ($26,120 for a married couple). Get more information about Medicare’s “Extra Help” program.
CMS Announces 27 Shared Savings ACO Program Participants — Akin Gump Health Reform Resource Center
As required by the Affordable Care Act, CMS established the Medicare Shared Savings ACO program. Under this program, ACOs are charged with improving care coordination for Medicare fee-for-service beneficiaries. ACOs that participate in the program have the opportunity to share in Medicare cost savings they achieve. In some circumstances, CMS holds ACOs accountable for failing to achieve cost savings (i.e., by making ACOs partially responsible for costs above established benchmarks).
S. 2101 (110th): Medicare Savings Program Improvement Act of 2007
Medicare Savings Program Improvement Act of 2007 – Amends title XIX (Medicaid) of the Social Security Act (SSA) with respect to the Qualified Medicare Beneficiaries (QMB) and Specified Low-Income Medicare Beneficiaries (SLMB) programs (Medicare Savings Program) to increase the income eligibility levels for: (1) QMBs to 135% of the federal poverty level (FPL); and (2) SLMBs to 150% of the FPL. Eliminates the application of estate recovery for Medicare Savings Program beneficiaries. Modifies the asset tests for QMBs and SLMBs. Directs the Secretary of Health and Human Services to provide for expedited enrollment under the Medicare Savings Program through Social Security offices. Provides for treatment of QMBs, SLMBs, and other dual eligibles as Medicare beneficiaries.
CMS picks 27 ACO participants for shared
More than 10,000 physicians, 10 hospitals, and 13 smaller physician-led entities and serve an estimated 375,000 beneficiaries will be included in the first ACOs. The announcement follows the January launch of the modified Pioneer Model ACOs with 32 healthcare groups and six Physician Group Practice Transition Demonstration organizations.
latest news: CMS Provides $46.5 Million to State Health Insurance Programs (SHIPs)
The SHIPs provide personalized, one-on-one counseling, information, education and outreach to help people understand their Medicare benefits. Medicare beneficiaries can get assistance with information and support for Medicare prescription drug coverage, Medicare Advantage plans, Medicare supplemental insurance policies, Medicare Savings Programs, long-term care insurance and financing, and other public and private health insurance coverage options. SHIPs also assist eligible participants to enroll in these programs and plans.