Federal officials are looking at ways to cut through old health care payment system reform mechanisms to try new reform mechanisms.
The Office of the Inspector General (OIG) at the U.S. Department of Health and Human Services Department (HHS) teamed with other agencies to organize a workshop recently to hear from participants’ thoughts on the accountable care organization (ACO) – a formal or informal group of providers that will take responsibility for caring for a whole patient.
Provisions in the Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act (PPACA), will encourage the Centers for Medicare and Medicaid Services (CMS) to use ACOs to try to improve the quality and reduce the cost of care.
The provisions do not require private payers to use ACOs, but CMS and private payers have already been testing ACOs and similar mechanisms for getting beyond the practice of paying a separate fee for each service provided, and private carriers often end up emulating new ideas that work well for CMS programs.
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The HHS OIG workshop focused on concerns about “antitrust, physician self-referral, anti-kickback, and civil monetary penalty laws.”
Congress passed those laws in the past because of allegations that physicians and hospitals were colluding to drive up health care prices.
“As Medicare and Medicaid programs move to incorporate and test payment and delivery models, there is a need for fresh thinking about program integrity and the types of risks for programs and patients,” Vicki Robinson, an HHS OIG staffer, said at the workshop, according to an ACO workshop transcript provided by the HHS OIG.
Affordable Care Act provisions give CMS and HHS OIG officials the ability to waive fraud