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CMS releases FAQs on Medicare Shared Savings Program

Posted on July 30, 2012 | No Comments

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Key Developments
Implementation Briefs

The Centers for Medicare & Medicaid Services (CMS) released frequently asked questions (FAQs) regarding the Medicare Shared Savings Program, a program established by the Affordable Care Act (ACA). Specifically, the guidance addresses Accountable Care Organizations (ACOs). ACOs are formed by providers that have agreed to work together to better coordinate patient care.

Information included in the FAQs include general facts regarding ACOs, the ACO participant list form CMS-588 electronic funds transfer, and governing body background.

On July 9, CMS announced 89 new ACOs had been selected to participate in the second wave of the Medicare Shared Savings Program.

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The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule, which addresses changes to the Affordable Care Act's (ACA) Medicare Shared Savings Program, including provisions relating to the payment of Accountable Care Organizations (ACO) participating in the Program.  The proposed rule includes several changes to eligibility requirements, definitions of an ACO participant, and how “pioneer” ACOs transition into the Medicare Shared Savings Program.  Notably, the rule would allow ACOs an extra three years without risk of penalties for poor performance, albeit with smaller shared savings for good performance. CMS also is considering making it easier for ACOs to meet spending targets by comparing them to providers in their region, instead of national comparisons, and by gradually making benchmarks less dependent on past ACO performance.
On Friday, the Centers for Medicare and Medicaid Services (CMS) released guidance explaining state considerations in designing and executing Medicaid Shared Savings Programs (MSSP). CMS provides flexibility for states in designing MSSP, yet CMS proclaimed they will not partner with state MSSP that only produce cost savings - the program must also improve health care quality and health outcomes. The guidance, in the form of a letter to State Medicaid Directors, does not prescribe a particular model the agency favors, but rather questions states should be able to answer in regards to the design approach they propose.
U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced yesterday that as of July 1, 2012, 89 new Accountable Care Organizations (ACOs) began serving 1.2 million people with Medicare in 40 states and Washington, D.C. ACOs are organizations formed by groups of doctors and other health care providers that have agreed to work together to coordinate care for people with Medicare. These 89 new ACOs have entered into agreements with CMS, taking responsibility for the quality of care they provide to people with Medicare in return for the opportunity to share in savings realized through high-quality, well-coordinated care. Federal savings from this initiative are estimated to be up to $940 million over four years. The 89 ACOs announced today bring the total number of organizations participating in Medicare shared savings initiatives to 154, including the 32 ACOs participating in the testing of the Pioneer ACO Model by CMS’s Center for Medicare and Medicaid Innovation (Innovation Center) announced last December, and six Physician Group Practice Transition Demonstration organizations that started in January 2011. 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 patient and caregiver experience of care.
The Centers for Medicare and Medicaid Services (CMS) have issued a notice of proposed rulemaking (NRPM) on Accountable Care Organizations (ACO). The proposed rule implements Section 3022 of the Affordable Care Act (ACA), which establishes certified ACOs as formal Medicare providers under the Medicare Shared Savings Program.
A report released by Premier found that commercial payers do not offer many of the low-risk, well-received Accountable Care Organization (ACO) payment models to providers that Medicare typically offers. Under the Affordable Care Act (ACA), the Medicare Shared Savings Program (MSPP) initiated two types of payment models: a savings model and a shared savings and loss model. The upside-risk track within the shared savings model is very popular with public programs, as there are no penalties for providers that do not meet their cost-savings goals. Payor Partnerships: Insights from Premier's PACT Population Health Collaborative found that upside-risk arrangements were not common in commercial payer partnerships. Additionally, the report emphasized that establishing a partnership with a payer makes the transition to an ACO more financially palatable for providers.
While a primary aim of the Affordable Care Act (ACA) was to increase access to affordable health insurance coverage, a critical, although less publicized, component of the law is a series of provisions designed to improve health care quality and efficiency and to advance the concept of “value-based purchasing.” The Agency for Health Care Research and Quality (AHRQ) defines the concept of value-based purchasing as holding “providers of health care accountable for both the cost and quality of care.” AHRQ notes that “value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. This strategy can be contrasted with more limited efforts to negotiate price discounts, which reduce costs but do little to ensure that quality of care is improved.”
An earlier Implementation Brief provided an overview of the Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs), which was established by §3022 of the Affordable Care Act (ACA) by adding §1899 to the Social Security Act. On April 7, 2011, the federal Centers for Medicare and Medicaid Services (CMS) published a proposed rule implementing the MSSP. This proposed rule was accompanied by several additional policy documents:
Introduces Accountable Care Organizations on a voluntary basis by directing the Secretary of Health and Human Services to develop a “Medicare Shared Savings Program.”