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PPACA: HHS Presses on with ACO Pilot

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The U.S. Department of Health and Human Services (HHS) is going ahead with efforts to recruit Medicare providers who are willing to test the “accountable care organization” approach to health care delivery.

The Centers for Medicare and Medicaid Services (CMS), the HHS arm that is running the Medicare Shared Savings Program, a Medicare ACO test program, is preparing to publish two ACO program documents in the Federal Register this week.

The first, set to appear Thursday, is a notice for a 3-day seminar for ACO managers. CMS is asking ACOs to send teams of 2 to 4 seior executives to participate.

The other document, set to appear Friday, is a request for providers to submit applications to participate in the “”Pioneer Accountable Care Organization Model,” during a period that is supposed to start this year and end in December 2016.

Letters of intent from the ACO pioneers are due June 18. Formal applications will be due July 18.

“To be eligible to participate in the Pioneer ACO Model, organizations would ideally already be coordinating care for a significant portion of patients under financial risk-sharing contracts and be positioned to transform both their care and financial models from fee-for-service to a three-part aim, value based model,” CMS officials say in an early version of the pioneer notice.

An ACO is supposed to be a vehicle for helping providers do a better job of working together. The providers that participate in the ACO share responsibility for providing health care for a patient, coordinate the patient’s care, and collect payments that depend at least partly on how well the group has managed the cost of the patient’s care.

The Medicare Shared Savings Program provision in the Patient Protection and Affordable Care Act of 2010 (PPACA) requires CMS to test the ACO concept on enrollees in the traditional Medicare fee-for-service (FFS) program, in an effort to hold down Medicare costs, improve the quality care and see whether the concept might also be useful to Medicaid plans and commercial health plans.

The PPACA provision had broad support, but CMS published an ACO programproposed rule in March that scared off many provider groups, including groups that have been strong supporters of ACO programs, according to health reform analysts at the Deloitte Center for Health Solutions, Washington.

Providers are nervous about the complexity of the proposed regulations, such as a proposal that might subject a pioneering ACO to a battery of 65 quality measures during the first year, the analyst say.

Providers also have questions about whether the CMS ACO savings goals are realistic, the analysts say.

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