Accountable Care Organizations Under Medicare Shared Savings Program PROPOSED RULE
|
|
- Darcy Caldwell
- 6 years ago
- Views:
Transcription
1 Accountable Care Organizations Under Medicare Shared Savings Program PROPOSED RULE
2 The information in this document summarizes a proposed rule issued by the Centers for Medicare and Medicaid id Services. It has been released for public comment and response and therefore does not have the force of law. Moreover, it is likely l to change in part when a final rule is issued. This document is presented for informational purposes only and is not intended d to provide consulting services or legal advice. Laws, regulations, and policies concerning these matters are complex and developing. Please consult with your counsel or consultant for any specific guidance or advice concerning ACOs. For specific details regarding ACOs please see the CMS website at: 2
3 Discussion Topics Background ACO Structure Quality Performance 4 Risk Sharing Models 5 6 Additional Considerations Summary 3
4 Background Healthcare reform legislation requires that the Secretary of Health and Human Services establish a Medicare Shared Savings Program by January 1, 2012 On April 7th, CMS published a proposed p rule for a Medicare Shared Savings Program via an Accountable Care Organization (ACO) model CMS will accept public comments through June 6th Some standards/requirements may change when a final rule is issued FTC, OIG and IRS released other documents to support implementation of the program 1 Patient Protection and Affordable Care Act, Pub. L. No (2010) [ACA]. 4
5 Background ACOs are one of the first delivery-reform initiatives to be implemented under the Affordable Care Act (ACA). ACOs are intended to provide: better care for individuals, better health for populations, and slower growth in costs through improvements in care. Each ACO will be responsible for the care of a defined population of Medicare beneficiaries assigned to it based on their use of primary care services. If an ACO succeeds in both delivering high-quality care and reducing the cost of that care, it will share in the Medicare savings it achieves. 5
6 What is an ACO? The proposed rule says an ACO is: A legal entity that is recognized and authorized under applicable state law, as identified by a Taxpayer Identification Number (TIN), and comprised of an eligible group of ACO participants that work together to manage and coordinate care for Medicare FFS beneficiaries and have established a mechanism for shared governance that provides all ACO participants with an appropriate proportionate control over the ACO s decision-making gprocess In other words: A group of providers and suppliers of services (e.g., hospitals, physicians, and others involved in patient care) that will work together to coordinate care for the patients they serve in Original Medicare. CMS, Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations, 76 Fed. Reg. 19,528, (April 7, 2011) [ACO Proposed Rule], 42 C.F.R
7 Overview Facts An Accountable Care Organization (ACO) is a type of Medicare shared savings program for Part A & B services Provider participation in an ACO is voluntary; patients may elect to use providers outside the ACO ACOs must: have at least 5,000 assigned Medicare beneficiaries participate in the program for a period of 3 years (subject to early termination provisions) have primary care physicians meet quality performance targets to qualify for shared savings select one of two models for risk sharing Application process will be known after the final rule is published Medicare providers that participate in an ACO will continue to be paid fee-for-service under the payment system for which they are eligible Any shared savings will be distributed to its participants according to their contractual arrangement with the ACO 7
8 ACO STRUCTURE 8
9 Who can form an ACO? Under the Affordable Care Act, the following participants may form an ACO: ACO professionals (e.g., physicians, physician assistants, nurse practitioners) in group practice arrangements Networks of individual practices of ACO professionals Partnerships or joint venture arrangements between hospitals and ACO professionals Hospitals employing ACO professionals Other groups of providers and suppliers as the Secretary deems appropriate ACA 3022 (2010). 9
10 ACO Governance CMS has proposed: that ACO participants control at least 75% of the governing body if an ACO has multiple participants, each should have a proportionate share of control inclusion of a beneficiary served by the ACO who meets certain conflict of interest requirements Governing Body 25% ACO Participants or their Representatives 75% Other, including Medicare Beneficiary ACO Proposed Rule, Eligibility and Governance, 42 C.F.R (d)(8); 425.5(d)(8)(ii). 10
11 ACO Management Governing Body Medical Director Clinical management Full-time Senior-level Board-certified physician Licensed in state of ACO Physically present Administrator Operations management Executive, officer, general partner or manager Governing body may appoint/remove Quality Assurance and Process Improvement Quality management Physician-directed Internal performance standards d Hold providers/suppliers accountable Identify/correct poor compliance Promote continuous quality improvement Data collection and evaluation infrastructure ACO Proposed Rule, Eligibility and Governance, 42 C.F.R (d)(9). 11
12 Primary and Specialty Care ACOs are required by statute to have a sufficient number of primary care providers to care for the beneficiaries assigned to the ACO Primary care providers may only join one ACO There is no parallel requirement for specialty providers; specialty providers may join and participate in more than one ACO Primary care and specialty physicians and hospitals may participate in shared savings according to the agreements they have with the ACO Primary Care Physicians Under ACOs Internal Family Medicine Practice General Practice Geriatric Medicine ACA, 3022(b)(2); ACO Proposed Rule, Definitions, 42 C.F.R
13 Beneficiary Assignment CMS is proposing that patients be retrospectively assigned to ACOs based on: Medicare primary care service utilization Care previously provided by a PCP who is an ACO provider during the year for which savings are to be calculated Where the plurality of primary care was received Patient ACO ACO Proposed Rule, Assignment of Medicare fee-for-servicefor beneficiaries to ACOs, 42 C.F.R
14 Beneficiary Notification Proposed rule would require ACO participants to notify Medicare beneficiaries about their ACO participation By posting signs in each of their facilities By providing a written notification to beneficiaries CMS plans to instruct ACOs to supply ppy a form allowing beneficiaries to opt-out of having their data shared CMS intends to develop a communication plan to directly provide Medicare beneficiaries with general information about the Shared Savings Plan CMS has specifically solicited comments regarding notification to Medicare beneficiaries ACO Proposed Rule, Assignment of Medicare fee-for-service beneficiaries to ACOs, 42 CFR 425.6(c); ACO Proposed Rule, Beneficiary Opportunity To Opt-Out of Claims Data Sharing, at 19,
15 Sample ACO Model Contract CMS Shared savings payment Medicare FFS payment ACO Primary Care Physicians * Hospital Specialists Other Providers Providers of Medicare Parts A & B services are paid FFS under the payment system for which they are eligible (IPPS, OPPS, PFS) * Physicians i with a specialty designation of internal medicine, i general practice, family practice, or geriatric i medicine i [ACO Proposed Rule, 42 C.F.R ]. 15
16 The ACO Agreement Submit application to CMS after final rule is published and before an established deadline CMS reviews application and determines whether to accept or deny If approved, the ACO must enter into a 3-year agreement with CMS ACO Proposed Rule, The 3-year agreement with CMS, 42 C.F.R
17 QUALITY PERFORMANCE 17
18 ACO Quality 5 Measure Domains 65 Patient/ caregiver experience Care coordination Patient safety Preventive health At risk population/ frail elderly health ACO Proposed Rule, Calculating the ACO quality performance score and determining shared savings eligibility, 42 C.F.R (a). ACO Proposed Rule, Quality and other reporting requirements, at 19,
19 Examples of ACO Quality Performance Measures Measure # Domain Title/Description Measure Type 1 Patient/caregiver t/ i Experience Clinician/Group CAHPS: How well do your doctors communicate? Patient t Experience of Care 8 Care Coordination/Transitions Risk-standardized, all condition readmission: rate of readmission within 30 days of hospital discharge Outcome 24 Patient Safety Healthcare acquired conditions Outcome 30 Preventive Health 40 At Risk Population Cholesterol management for patients with cardiac conditions Diabetes mellitus: hemoglobin A1c poor control (>9%): percentage of patients aged with diabetes mellitus who had most recent hemoglobin A1c > 9% Process & Outcome Outcome ACO Proposed Rule, Quality and other reporting requirements, at 19,
20 Quality Performance Standard Data Collection Methods Claims Surveys ACO Group Practice Reporting Option tool Measure scoring Measure scoring Reporting year 1 (2012) year 2 year 3 Performance ACO Proposed Rule, Quality and other reporting requirements, at 19,592; ACO Proposed Rule, Calculating the ACO quality performance score and determining shared savings eligibility, 42 C.F.R (a); (b). 20
21 Relationship to Other Quality Programs To the extent possible and appropriate, CMS proposes to align the ACO quality measures with those of existing quality programs ACO participants/suppliers that are also eligible professionals (EPs) under the Physician Quality Reporting System (PQRS) may earn the PQRS incentive by meeting the ACO s quality performance standards* The e-prescribing (erx) and Electronic Health Record (EHR) Incentive program requirements may not be met through satisfying the ACO quality requirements Public reporting of ACO quality performance scores would be required At least 50 percent of an ACO s primary care physicians must be meaningful EHR users, using certified EHR technology, by the start of the second performance year * An EP would not qualify to earn a PQRS incentive as both a group that is part of an ACO and as an individual ACO Proposed Rule, Quality and other reporting requirements, at 19,570; ACO Proposed Rule, Incorporating other reporting requirements related to the Physician Quality Reporting System and electronic health records technology, at 19, ; 42 C.F.R
22 RISK SHARING MODELS 22
23 What is a Benchmark? Adjustment Factors Weighted average of beneficiary s Medicare A & B spend from prior 3 yrs Adjustment Factors Beneficiary risk & growth adjuster Growth in national FFS Medicare A&B spend* Geographic differentials Teaching hospital and DSH add-ons truncated at 99 th percentile ACO Benchmark ACO Proposed Rule, Payment and treatment of savings, 42 C.F.R
24 How are ACO members paid? ACO healthcare providers will continue to be paid fee-for-service under the Medicare payment system for which they are eligible (IPPS, PFS, etc.) ACOs will receive a payment for shared savings if: The ACO meets certain defined quality performance requirements AND Costs are below a performance target and minimum savings rate (MSR) set by CMS Non-ACO members do not share in savings Each ACO will decide how to internally share savings among members (formula will vary by ACO) ACO Proposed Rule, 42 C.F.R ; 425.7(c)(2). 24
25 Payment Models The rule proposes two payment tracks for participating in the Shared Savings Program: Design Track 1 Track 2 Element Years 1 & 2 Year 3 Years 1,2 & 3 (one-sided) (two-sided) (two-sided) Shared savings* X X X Savings cap X X X Shared losses X X Loss cap** X X * The total allowable shared savings in years 1 & 2 for the one-sided model is less than for the two-sided model ** The proposed rule provides a limit on maximum potential loss or risk for ACOs ACO Proposed Rule, Payment and treatment of savings, 42 C.F.R (c) & (d) 25
26 Repayment of Losses CMS proposes methods by which to protect itself from losses Establish repayment mechanisms : - reinsurance - escrow funds - line of credit 25% withholding of any shared savings amount ACO Proposed Rule, Payment and treatment of savings, 42 C.F.R (d)(6)(iii); 425.5(d)(6)(iv). 26
27 ADDITIONAL CONSIDERATIONS 27
28 Guiding Principles Individualized care Patient-Centeredness Patient access to clinical information and medical records Provider and patient partnership for planning Assessment of the care experience Integration of care with community resources Patient information flows across care transitions Sample Criteria Involve patients in ACO governance Communicate clinical i l information in a way that t is understandable d to beneficiaries Share decision-making in a way that considers beneficiaries unique needs, preferences, values and priorities ACO Proposed Rule, Eligibility and Governance, 42 C.F.R (d)(15)(ii). 28
29 Patient Protections Proposed policy: Patients must be informed that their healthcare providers are participating in an ACO ACO marketing materials (e.g., brochures, web pages, etc.) must be approved dby CMS Patients can freely use hospitals and doctors outside an ACO Beneficiaries may opt out of having individual data, including Medicare Part D data, shared with an ACO The governing body must include Medicare beneficiary representative(s) served by the ACO CMS will monitor the ACO to prevent avoidance of at-risk beneficiaries ACO Proposed Rule, 42 C.F.R (d)(5); ACO Proposed Rule, ACO Marketing Guidelines, at 19,551; 42 C.F.R (a)(2); (f)&(g); 425.(d)(8)(ii); (b); (a). 29
30 Compliance Requirements Compliance Official Law Enforcement Compliance Plan Issue Identification Training Program Issue Reporting ACO Proposed Rule, Compliance plan, 42 C.F.R (d)(10). 30
31 Complementary Guidance Additional ACO guidance documents were released in conjunction with the proposed rule: Office of Inspector General (OIG) Application to ACOs of Stark Law, Anti-Kickback Statute and Civil Monetary Penalties Law Department of Justice and Federal Trade Commission Antitrust Guidelines Internal Revenue Service (IRS) Tax exempt organization guidance Available at: 31
32 SUMMARY 32
33 Summary ACOs are one of the first delivery reforms under ACA: Primary care provider participation is required to create an ACO; however, specialty care providers may also participate Individual Medicare providers and suppliers will continue to receive payments under the normal Medicare fee-for-service payment system Hospital and physician participation in the Medicare Shared Savings Program is voluntary Physicians who treat ACO beneficiaries but are not ACO participants p will not share in the potential benefits/risks under the Shared Savings Program Beneficiaries who are assigned to an ACO are free to see providers in or out of the ACO. 33
34 Comments To comment on the proposed rule: Electronic: gov By mail: Centers for Medicare & Medicaid Services Attention: CMS-1345-P P.O. Box 8013 Baltimore, MD To be assured consideration, public comments must be received no later than 5:00 p.m. ET on June 6,
ACO REVIVAL. Medicare Shared Savings Program Final Regulation Overview. Blue & Co., LLC Healthcare Reform Symposium Thursday, November 3, 2011
ACO REVIVAL Medicare Shared Savings Program Final Regulation Overview Blue & Co., LLC Healthcare Reform Symposium Thursday, November 3, 2011 11/03/2011 1 Introductions John Redding, MD, MBA Manager Healthcare
More informationThe Accountable Care Organization & Compliance
The Accountable Care Organization & Compliance Joy A. Heim, Compliance Officer Franciscan ACO, Inc. HCCA Regional Conference Indianapolis, Indiana September 30, 2016 1 Creation of Medicare Accountable
More informationThe Accountable Care Organization & Compliance
The Accountable Care Organization & Compliance Joy A. Heim, Compliance Officer Franciscan ACO, Inc. HCCA Regional Conference Indianapolis, Indiana September 30, 2016 1 Creation of Medicare Accountable
More informationPractice Implications for Accountable Care Organizations
Practice Implications for Accountable Care Organizations An Overview following the Final Rule Gregory M. Marsh, MPH, PMP December 14, 2011 Why CCME? Effective EHR/HIE Implementation will: Improve patient
More informationPhysician Only ACOs: An Opportunity to Consider * Elias N. Matsakis, Esq.
Physician Only ACOs: An Opportunity to Consider * Elias N. Matsakis, Esq. The Affordable Care Act authorized the Center for Medicare and Medicaid Services (CMS) to establish the Medicare Shared Savings
More information3/29/2013. Effective ACO Compliance. Objectives THE HEALTH CARE DILEMMA: ARE ACOS THE ANSWER? HCCA Compliance Institute April 21, 2013
Effective ACO Compliance HCCA Compliance Institute April 21, 2013 Margaret Hambleton, MBA, CHC, CHPC Sr. Vice President, Chief Compliance Officer St. Joseph Health System 1 Objectives Understand Accountable
More informationRequest for Information Regarding Accountable Care Organizations (ACOs) and Medicare Shared Savings Programs (CMS-1345-NC)
Via Electronic Submission Donald Berwick, MD, MPP Administrator Centers for Medicare & Medicaid Services ATTN: CMS-1345-NC 7500 Security Blvd. Baltimore, MD 21244-8013 Re: Request for Information Regarding
More informationCMS Bundled Payments Initiative
October 4, 2011 Practice Groups: Health Care Health Care Reform CMS Bundled Payments Initiative By Richard P. Church and Irene B. Nsiah The Patient Protection and Affordable Care Act ( PPACA ), Pub. Law
More informationAccountable Care Organizations. What the Nurse Executive Needs to Know. Rebecca F. Cady, Esq., RNC, BSN, JD, CPHRM
JONA S Healthcare Law, Ethics, and Regulation / Volume 13, Number 2 / Copyright B 2011 Wolters Kluwer Health Lippincott Williams & Wilkins Accountable Care Organizations What the Nurse Executive Needs
More informationAccountable Care Organizations: Process and Applications. Presentation to South Carolina Hospital Association CO CFO Forum.
Accountable Care Organizations: Lessons Learned from the ACO Process and Applications Presentation to South Carolina Hospital Association CO CFO Forum TheSea PinesResort Hilton Head, SC August 28, 2013
More informationBenchmark Data Sources
Medicare Shared Savings Program Quality Measure Benchmarks for the 2016 and 2017 Reporting Years Introduction This document describes methods for calculating the quality performance benchmarks for Accountable
More informationREPORT OF THE BOARD OF TRUSTEES
REPORT OF THE BOARD OF TRUSTEES B of T Report 21-A-17 Subject: Presented by: Risk Adjustment Refinement in Accountable Care Organization (ACO) Settings and Medicare Shared Savings Programs (MSSP) Patrice
More informationRE: RIN 0938-AQ22, Final Rule, Section 3022 of the Affordable Care Act, Medicare Shared Savings Program: Accountable Care Organizations
20 F Street, NW, Suite 200 Washington, D.C. 20001 202.558.3000 Fax 202.628.9244 www.businessgrouphealth.org Creative Health Benefits Solutions for Today, Strong Policy for Tomorrow November 29, 2011 The
More informationImproving Quality of Care for Medicare Patients: Accountable Care Organizations
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Improving Quality of Care for Medicare Patients: FACT SHEET Overview http://www.cms.gov/sharedsavingsprogram On October
More informationThe Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization. Quality Forum August 19, 2015
The Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization Quality Forum August 19, 2015 Ross Manson rmanson@eidebailly.com 701.239.8634 Barb Pritchard bpritchard@eidebailly.com
More informationAccountable Care Organizations: Organizational and Legal Structures; Governance
Accountable Care Organizations: Organizational and Legal Structures; Governance California Association of Physician Groups (CAPG) May 4, 2011 Palm Desert, CA Dennis S. Diaz, Esq. Davis Wright Tremaine
More informationHospice Program Integrity Recommendations
Hospice Program Integrity Recommendations Projected increases in the elderly population and the number of Medicare beneficiaries will likely result in continued growth in utilization of hospice services.
More informationThe Accountable Care Organization Specific Objectives
Accountable Care Organizations and You E. Christopher h Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences CEO, OSU Faculty Group Practice Chair, Department of Surgery Ohio State
More informationStrategic Implications & Conclusion
Kelly Court Chief Quality Officer Wisconsin Hospital Association Brian Vamstad Government Relations Consultant Gundersen Health System Overview and Key Takeaways of the Medicare Quality Payment Program
More informationDiane Meyer, CHC (650) Agenda
The Road Ahead and How to Navigate It Kevin D. Lyles, Esq. kdlyles@jonesday.com (614) 281-3821 Diane Meyer, CHC DMeyer@stanfordmed.org (650) 724-2572 Frank E. Sheeder, Esq. fesheeder@jonesday.com (214)
More informationProposed 2015 PFS: Quality Updates
SCGX1423 08/14 Proposed 2015 PFS: Quality Updates Johnson & Johnson Health Care Systems Inc. Providing services for: Janssen Biotech, Inc. Janssen Pharmaceuticals, Inc August, 2014 This document is presented
More informationQuality Payment Program MIPS. Advanced APMs. Quality Payment Program
Proposed Rule: Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models The Department
More informationMACRA Frequently Asked Questions
Following the release of the Quality Payment Program Interim Final Rule, the American Medical Association (AMA) conducted numerous informational and training sessions for physicians and medical societies.
More informationHealth Care Evolution
Health Care Evolution Patient-Centered Medical Home to Clinical Integration & Accountable Care Ken Bertka, MD bertka@mindspring.com 419-346-8719 Agenda Top 3 Challenges of Health Care Reform PCMH & ACO
More informationRE: File Code CMS-1345-P Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations
Donald Berwick, M.D., M.P.P. Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1345-P Room 445-G Hubert H. Humphrey Building 200 Independence Ave. S.W. Washington,
More informationWhat Have we Learned from the Pioneer ACO Model?
What Have we Learned from the Pioneer ACO Model? Sherly Binu, CMMI December 7, 2016 Disclaimers 2 This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose
More informationkaiser medicaid and the uninsured commission on O L I C Y
P O L I C Y B R I E F kaiser commission on medicaid and the uninsured 1330 G S T R E E T NW, W A S H I N G T O N, DC 20005 P H O N E: (202) 347-5270, F A X: ( 202) 347-5274 W E B S I T E: W W W. K F F.
More informationDivision C: Increasing Choice, Access, and Quality in Health Care for Americans TITLE XV: Provisions Relating to Medicare Part A
Division C: Increasing Choice, Access, and Quality in Health Care for Americans TITLE XV: Provisions Relating to Medicare Part A Sec. 15001. Development of Medicare study for HCPCS versions of MS-DRG codes
More informationACOs: California Style
ACOs: California Style ACO Congress John E. Jenrette, M.D. Chief Executive Officer Sharp Community Medical Group November 2, 2011 California Style California Style A CO California Style California Style
More informationHealth Care Reform Provisions Affecting Older Adults and Persons with Special Needs 3/30/10
Health Care Reform Provisions Affecting Older Adults and Persons with Special Needs 3/30/10 On March 23, 2010, President Obama signed a comprehensive health care reform bill (H.R. 3590) into law. On March
More informationAssignment of Medicare Fee-for-Service Beneficiaries
February 6, 2015 Ms. Marilyn B. Tavenner, Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1461-P Room 445-G, Hubert H. Humphrey Building 200
More informationQuality Measurement and Reporting Kickoff
Quality Measurement and Reporting Kickoff All Shared Savings Program ACOs April 11, 2017 Sandra Adams, RN; Rabia Khan, MPH Division of Shared Savings Program Medicare Shared Savings Program DISCLAIMER
More informationPhysician Compensation in an Era of New Reimbursement Models
2014 IHA Annual Membership Meeting Physician Compensation in an Era of New Reimbursement Models Taryn E. Stone Ice Miller LLP (317) 236-5872 taryn.stone@ Agenda Background New Reimbursement Models Trends
More informationDecember 3, 2010 BY COURIER AND ELECTRONIC MAIL
Charles N. Kahn III President & CEO December 3, 2010 BY COURIER AND ELECTRONIC MAIL Donald Berwick, M.D. Administrator Centers for Medicare & Medicaid Services Attention: CMS-6028-P Hubert H. Humphrey
More informationState Leadership for Health Care Reform
State Leadership for Health Care Reform Mark McClellan, MD, PhD Director, Engelberg Center for Health Care Reform Senior Fellow, Economic Studies Leonard D. Schaeffer Chair in Health Policy Studies Brookings
More informationPHCA Webinar January 30, Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq.
PHCA Webinar January 30, 2014 Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq. 1 2 Intended to: Encourage the development of ACOs in Medicare Promotes accountability for a patient population and coordinates
More informationCMS Quality Payment Program: Performance and Reporting Requirements
CMS Quality Payment Program: Performance and Reporting Requirements Session #QU1, February 19, 2017 Kristine Martin Anderson, Executive Vice President, Booz Allen Hamilton Colleen Bruce, Lead Associate,
More informationMedicare Physician Payment Reform:
Medicare Physician Payment Reform: Implications and Options for Physicians and Hospitals Background The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law on April 14, 2015.
More informationUnited Medical ACO Participation Criteria
United Medical ACO Participation Criteria Items Requiring Practice Reporting 1) Submission of Reports: Practices must report A,B, and C to UMACO A. Thirty-four ACO Quality Measures -See Appendix A B. Average
More informationACOs the Medicare Shared Savings Program And Other Healthcare Reform Payment Methods
A unique vision for an ever-changing healthcare environment ACOs the Medicare Shared Savings Program And Other Healthcare Reform Payment Methods Presented by Joe Laden, President, ORVA, LLC The Environment
More informationQUALITY PAYMENT PROGRAM
NOTICE OF PROPOSED RULE MAKING Medicare Access and CHIP Reauthorization Act of 2015 QUALITY PAYMENT PROGRAM Executive Summary On April 27, 2016, the Department of Health and Human Services issued a Notice
More informationRe: Payment Policies under the Physician Fee Schedule Proposed Rule for CY 2014; 78 Fed. Reg. 43,281 (July 19, 2013); CMS-1600; RIN 0938-AR56
September 6, 2013 Marilyn B. Tavenner Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Hubert H. Humphrey Building, Room 445-G 200 Independence Avenue, SW
More informationDecoding the QPP Year 2 Quality Measure Benchmarks and Deciles to Maximize Performance
Decoding the QPP Year 2 Quality Measure Benchmarks and s to Maximize Performance Leila Volinsky, MHA, MSN, RN, PCMH CCE, CPHQ Senior Program Administrator New England Regional Lead Quality Payment Program
More informationTechnical Overview of HCIP/CCIP
Technical Overview of HCIP/CCIP Using Care Redesign to Align Provider Incentives Presentation to HFMA, Maryland Chapter HSCRC Care Redesign Summit August 18, 2017 Facilitators Nicole Stallings Vice President,
More informationFurthering the agency s stated intention to pay for value over volume,
in the news Health Care September 2016 The Future Is Now: CMS Proposes Broad Bundled Payment Expansion for Cardiac Care Episodes In this Issue: Episode Payment Models... 2 Cardiac Rehabilitation Incentives...
More informationFebruary 9, 2012 Orlando, Florida
American Health Lawyers Association Physician and Physician Organizations Law Institute Regulatory & Payment Issues and the Patient Centered Medical Home February 9, 2012 Orlando, Florida John E. Wyand,
More informationQuality Measurement at the Interface of Health Care and Population Health
1 Institute of Medicine Committee on Quality Measures Healthy People Leading Health Indicators December 10, 2012 Quality Measurement at the Interface of Health Care and Population Health Shari M. Ling,
More information3/16/2016. Swapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider. AKS designed to prevent improper referrals, which can lead to:
Swapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider Alan Schabes, Partner Benesch, Friedlander, Coplan & Aronoff LLP Shannon Drake, VP, Associate General Counsel Kindred at Home Amanda
More informationWELCOME. Kate Gainer, PharmD Executive Vice President and CEO Iowa Pharmacy Association
WHAT IS MACRA? WELCOME Kate Gainer, PharmD Executive Vice President and CEO Iowa Pharmacy Association WELCOME Anthony Pudlo, PharmD, MBA, BCACP Vice President of Professional Affairs Iowa Pharmacy Association
More informationCleveland State University. Benjamin Holland Able
Cleveland State University EngagedScholarship@CSU Journal of Law and Health Law Journals 2013 The Stark Physician Self-Referral Law and Accountable Care Organizations: Collision Course or Opportunity to
More informationPreparing for DSRIP: Legal and Strategic Issues for Long-Term Care Providers. LeadingAge New York Webinar
Preparing for DSRIP: Legal and Strategic Issues for Long-Term Care Providers LeadingAge New York Webinar November 10, 2014 Tracy E. Miller, Esq. Health Care Group Bond, Schoeneck & King, PLLC Delivery
More informationSwapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider
Swapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider Alan Schabes, Partner Benesch, Friedlander, Coplan & Aronoff LLP Shannon Drake, VP, Associate General Counsel Kindred at Home Amanda
More informationAgenda. Surviving the New Program Requirements and the Financial Penalties Under MIPS 9/9/2016. Steps to take to prepare for MIPS
Surviving the New Program Requirements and the Financial Penalties Under MIPS September 2016 Selena Hood Agenda Steps to take to prepare for MIPS Introduction and Evaluation of the Merit-Based Incentive
More information2017/2018. KPN Health, Inc. Quality Payment Program Solutions Guide. KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc.
2017/2018 KPN Health, Inc. Quality Payment Program Solutions Guide KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc. 214-591-6990 info@kpnhealth.com www.kpnhealth.com 2017/2018
More informationESSENTIAL STRATEGIES IN MEDI-CAL PAYMENT REFORM. Richard Popper, Director, Medicaid & Duals Strategy August 3, 2017
ESSENTIAL STRATEGIES IN MEDI-CAL PAYMENT REFORM Richard Popper, Director, Medicaid & Duals Strategy August 3, 2017 1 DISCLAIMER The enclosed materials are highly sensitive, proprietary and confidential.
More informationExhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013)
Exhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013) 24 percent (52 ACOs) earned shared savings bonus 27 percent (60 ACOs) reduced spending,
More informationThings You Need to Know about the Meaningful Use
Things You Need to Know about the Meaningful Use This guide is intended to assist you through the questions related to Meaningful Use and its implications in your practice. Note that this is completely
More informationExecutive Summary, November 2015
Medicare Physician Fee Schedule Final Rule for Calendar Year 2016 Makes Changes in Stark Law Regulatory Provisions and Contains Important Updates of Medicare Payment Policies Executive Summary, November
More informationI. Disclosure Requirements for Financial Relationships Between Hospitals and Physicians
2400:1018 BNA s HEALTH LAW & BUSINESS SERIES provided certain additional elements (based largely on the physician recruitment exception) are satisfied. 133 10. Professional courtesy, 42 C.F.R. 411.357(s)
More informationMEMORANDUM. TO: Infectious Diseases Society of America FROM: King & Spalding
King & Spalding LLP 1700 Pennsylvania Ave, NW Suite 200 Washington, D.C. 20006-4707 Tel: +1 202 737 0500 Fax: +1 202 626 3737 www.kslaw.com MEMORANDUM TO: Infectious Diseases Society of America FROM: King
More informationCMS in the 21 st Century
CMS in the 21 st Century ICE 2013 ANNUAL CONFERENCE David Saÿen, MBA Regional Administrator Centers for Medicare & Medicaid Services San Francisco November 15, 2013 The strategy is to concurrently pursue
More informationMIPS/APM Proposed Rule Summary On Monday, May 9, 2016 the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register the
MIPS/APM Proposed Rule Summary On Monday, May 9, 2016 the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register the proposed criteria for the Quality Payment Program as prescribed
More informationQUALITY AND COMPLIANCE
2015 HCCA SOUTHEAST CONFERENCE JANUARY 23, 2015 QUALITY AND COMPLIANCE Katie Fink Donna Lewis Susan Walberg Presenters Katie Fink Senior Counsel Office of Counsel to the Inspector General U.S. Department
More information2016 Requirements for the EHR Incentive Programs: EligibleProfessionals
2016 Requirements for the EHR Incentive Programs: EligibleProfessionals Vidya Sellappan Division of Health Information Technology Quality Measurement & Value-based Incentives Group Center for Clinical
More informationMeaningful Use of EHR Technology:
Meaningful Use of EHR Technology: What Do the New Standards and Certification Criteria Mean for Your Organization? January 20, 2010 Mitchell J. Olejko Ropes & Gray LLP mitchell.olejko@ropesgray.com 415-315-6328
More informationThe Quality Payment Program Overview Fact Sheet
Quality Payment Program The Quality Payment Program Overview Background On October 14, 2016, the Department of Health and Human Services (HHS) issued its final rule with comment period implementing the
More informationMACRA and MIPS. How Medicare Meaningful Use and PQRS are Changing
MACRA and MIPS How Medicare Meaningful Use and PQRS are Changing Link to recorded session: https://attendee.gotowebinar.com/recording/1305549490878052097 Presenting Today: Molly Goodhart Joined Quatris
More informationCalendar Year 2014 Medicare Physician Fee Schedule Final Rule
Calendar Year 2014 Medicare Physician Fee Schedule Final Rule Non-Facility Cap After receiving many negative comments on this issue from physician groups, along with the House GOP Doctors Caucus letter
More informationAMGA Webinar: MSSP Final Rule. Scott Hines, MD Chief Quality Officer Crystal Run Healthcare July 16, 2015
AMGA Webinar: MSSP Final Rule Scott Hines, MD Chief Quality Officer Crystal Run Healthcare July 16, 2015 Crystal Run Healthcare Physician owned MSG in NY State, founded 1996 >350 providers, >30 locations
More informationWhat should board members know about new health care reform payment structures?*
What should board members know about new health care reform payment structures?* Passage and implementation of the Patient Protection and Affordable Care Act (ACA) has driven America s health care system
More informationMoving the Dial on Quality
Moving the Dial on Quality Washington State Medical Oncology Society November 1, 2013 Nancy L. Fisher, MD, MPH CMO, Region X Centers for Medicare and Medicaid Serving Alaska, Idaho, Oregon, Washington
More informationPROVIDER HANDBOOK. Informed Care. Improved Health.
PROVIDER HANDBOOK Informed Care. Improved Health. ACO_HdBk6_1215_IA Approved A1274_HdBk6_1215 Table of Contents Chapter 1 Informed Care. Improved Health...2 Chapter 2 Beneficiary Engagement...6 Chapter
More informationACCOUNTABLE CARE ORGANIZATION & ALTERNATIVE PAYMENT MODEL SUMMIT
ACCOUNTABLE CARE ORGANIZATION & ALTERNATIVE PAYMENT MODEL SUMMIT The Centers for Medicare and Medicaid Services Kate Goodrich, MD MHS Director, Clinical Standards & Quality Chief Medical Officer 1 DISCLAIMERS
More informationPhysician Quality Reporting System (PQRS) Changes
Physician Quality Reporting System (PQRS) Changes Summary: Extends through 2014 payments under the Physician Quality Reporting System (PQRS, formerly the Physician Quality Reporting Initiative or PQRI)
More informationCPC+ Application Process
Practice Eligibility CPC+ Application Process In order to participate, all CPC+ practices must have multi-payer support, adopt certified health IT requirements for reporting, and other infrastructural
More informationValue-Based Care Contracting and Legal Issues
Session 4b Value-Based Care Contracting and Legal Issues Presented by: Janet Walker Farrer General Counsel and Insurance Legal Department Chair Ascension Health Leah Stewart Associate Vice President for
More informationMACRA for Critical Access Hospitals. Tuesday, July 26, 2016 Webinar
MACRA for Critical Access Hospitals Tuesday, July 26, 2016 Webinar MACRA presenters Harold D. Miller, President & CEO CHQPR Claudia Sanders, Sr. Vice President, Policy Development Andrew Busz, Policy Director,
More informationMACRA Implementation: A Review of the Quality Payment Program
MACRA Implementation: A Review of the Quality Payment Program Neal Logue, Kirk Sadur Centers for Medicare and Medicaid Services, Region IX, September 15, 2017 Disclaimer This presentation was prepared
More informationRE: CMS-1677-P; Medicare Program; Request for Information on CMS Flexibilities and Efficiencies
June 13, 2017 Ms. Seema Verma Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-1677-P P.O. Box 8011 Baltimore, MD 21244-1850 RE: CMS-1677-P;
More informationCMS Quality Program Overview
CMS Quality Program Overview AMGA/Press Ganey Survey Collaboration September 13, 2012 Presenter Information Incorporated in 1985, Press Ganey was one of the first companies to provide patient satisfaction
More informationPartnering with hospitals to create an accountable care organization Elias N. Matsakis, Esq.
Partnering with hospitals to create an accountable care organization Elias N. Matsakis, Esq. There are many opportunities for physicians and hospitals to affiliate and clinically integrate so as to enable
More informationAccountable Care and Governance Challenges Under the Affordable Care Act
Accountable Care and Governance Challenges Under the Affordable Care Act The First National Congress on Healthcare Clinical Innovations, Quality Improvement and Cost Containment October 26, 2011 Doug Hastings
More informationWhat is the QRUR? Understanding Your Annual Quality and Resource Use Report
What is the QRUR? Understanding Your Annual Quality and Resource Use Report What is the Quality and Resource Use Report? The Quality and Resource Use Report (QRUR) is a mid-year and annual report card
More informationKate Goodrich, MD MHS. Director, Center for Clinical Standards & Quality. Center for Medicare and Medicaid Services (CMS) May 6, 2016
Kate Goodrich, MD MHS Director, Center for Clinical Standards & Quality Center for Medicare and Medicaid Services (CMS) May 6, 2016 THE MEDICARE ACCESS & CHIP REAUTHORIZATION ACT OF 2015 Quality Payment
More information7/7/17. Value and Quality in Health Care. Kevin Shah, MD MBA. Overview of Quality. Define. Measure. Improve
Value and Quality in Health Care Kevin Shah, MD MBA 1 Overview of Quality Define Measure 2 1 Define Health care reform is transitioning financing from volume to value based reimbursement Today Fee for
More informationAccelerating the Impact of Performance Measures: Role of Core Measures
Accelerating the Impact of Performance Measures: Role of Core Measures Mark McClellan, MD, PhD Director, Engelberg Center for Health Care Reform Senior Fellow, Economic Studies Leonard D. Schaeffer Chair
More informationTHE REIMBURSEMENT SHIFT: PREPARING YOUR PRACTICE FOR PATIENT-CENTERED PAYMENT REFORM. November 20, 2015
THE REIMBURSEMENT SHIFT: PREPARING YOUR PRACTICE FOR PATIENT-CENTERED PAYMENT REFORM November 20, 2015 TODAYS PRESENTERS Kavon Kaboli Consultant Galen Healthcare Solutions Cece Teague Consultant Galen
More informationMedicare & Medicaid EHR Incentive Programs. Stage 2 Final Rule Pennsylvania ehealth Initiative All Committee Meeting November 14, 2012
Medicare & Medicaid EHR Incentive Programs Stage 2 Final Rule Pennsylvania ehealth Initiative All Committee Meeting November 14, 2012 What is in the Rule Changes to Stage 1 of meaningful use Stage 2 of
More informationPerson-Centered Accountable Care
Person-Centered Accountable Care Nelly Ganesan, MPH, Senior Director, Avalere s Evidence, Translation and Implementation Practice October 12, 2017 avalere.com @NGanesanAvalere @avalerehealth Despite Potential
More informationStep-by-Step Calculations for Value-Based Purchasing
Overview Hospitals participating in the Hospital VBP Program have the opportunity to review their FY 2019 PPSR. This quick reference guide offers an overview of how CMS calculates scores and awards points
More information2013 Health Care Regulatory Update. January 8, 2013
2013 Health Care Regulatory Update January 8, 2013 Quality-Based Payment Reform, ACOs and Clinical Integration Bruce Johnson and Tom Donohoe Overview Quality-based payment reform programs Major programs
More informationAdvancing Care Coordination Proposed Rule
Advancing Care Coordination Proposed Rule Released July 25, 2016 Erin Smith, JD VP and Executive Director, PACCR Jourdan Meltzer Research Associate, PACCR August 4, 2016 1 Presentation Overview Three new
More informationAccountable Care and Shared Savings Program Where Do Urologists Fit In?
5 th Annual AACU State Society Network Meeting September 22-23, 2012 Accountable Care and Shared Savings Program Michael R. Callahan Katten Muchin Rosenman LLP 525 West Monroe Street Chicago, Illinois
More informationExecutive Summary BERKELEY RESEARCH GROUP COMPLIANCE TRENDS WITH HOSPITAL CHARITY CARE REQUIREMENTS
Executive Summary Study Background: The Affordable Care Act (ACA) established new requirements for 501(c)(3) hospitals pertaining to their charity care policies. Hospitals self-report data related to these
More informationRoll Out of the HIT Meaningful Use Standards and Certification Criteria
Roll Out of the HIT Meaningful Use Standards and Certification Criteria Chuck Ingoglia, Vice President, Public Policy National Council for Community Behavioral Healthcare February 19, 2010 Purpose of Today
More informationSVS QUALITY AND PERFORMANCE MEASURES COMMITTEE (QPMC) New Member Orientation
SVS QUALITY AND PERFORMANCE MEASURES COMMITTEE (QPMC) New Member Orientation 2017-2018 SVS QPMC Quality and Performance Measures Committee Policy and Advocacy Council (Chair Sean Roddy) Chair: Brad Johnson,
More informationEHR Incentive Programs: 2015 through 2017 (Modified Stage 2) Overview
EHR Incentive Programs: 2015 through (Modified Stage 2) Overview CMS recently released a final rule that specifies criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals
More informationHCCA South Central Regional Annual Conference November 21, 2014 Nashville, TN. Post Acute Provider Specific Sections from OIG Work Plans
HCCA South Central Regional Annual Conference November 21, 2014 Nashville, TN Kelly Priegnitz # Chris Puri # Kim Looney Post Acute Provider Specific Sections from 2012-2015 OIG Work Plans I. NURSING HOMES
More information1. The new state-based insurance exchange for small businesses (SHOP) stands for:
Chapter 5 Review Questions 1. The new state-based insurance exchange for small businesses (SHOP) stands for: a. Small Business Health Options Program b. Small Business Health Option Plans c. State Health
More informationRegistering for PQRS Reporting and Understanding the Implications and Proposed Policies for the Value based Payment Modifier
Registering for PQRS Reporting and Understanding the Implications and Proposed Policies for the Value based Payment Modifier Presented by: Centers for Medicare and Medicaid Services Performance Based Payment
More information