ACO Final Rule Accompanied by Advance Payments for Care Coordination Tools

Monday, October 24th, 2011
This post was written by Cheryl Miller

The anxiously awaited final rule on accountable care organizations (ACOs) for Medicare beneficiaries is finally out. Based on the more than 1300 comments CMS received on its proposed ACO ruling first released in March, this new rule will make it easier to establish ACOs by providing organizations with additional funding for support tools, such as new staff or information technology systems. Under this new initiative, the Advanced Payment Model, these payments would be recovered from any future shared savings.

The second initiative, the Medicare Shared Savings Program, will provide incentives for healthcare providers who agree to work together and become accountable for coordinating care for patients. Participants who meet certain quality standards based upon, among other measures, patient outcomes and care coordination among the provider team, may share in savings they achieve for the Medicare program. Both initiatives launched on October 20th.

The United States earned low marks in healthcare access and affordability in the Commonwealth Fund’s third annual scorecard report. According to the report, the nation received a 64 out of a possible 100 when compared to best performers. Among the findings that contributed to the score were the percentage of overweight or obese children (32 percent), the number of prescription errors among elderly Medicare beneficiaries (one out of four) and the percentage of adults that reported not having a primary care provider in 2008 (44 percent).

Despite the low scores in key quality indicators, the United States is doing something right in the area of heart failure (HF) care. New research from the Yale School of Medicine shows that hospitalization rates for HF dropped by 30 percent from 1998 to 2008. One year mortality rates also dropped slightly during this period. HF ranks as the most frequent cause of hospitalization and re-hospitalization among older Americans, with related costs estimated at $39.2 billion in 2010.

In other news, 46 percent of physician practices do not meet NCQA standards for medical homes. The news, from a recent University of Michigan-led study, found that while larger, multi-specialty practice groups can more easily meet the standards, one in nine Americans receive healthcare from smaller, often solo practices. Researchers recommend initiatives to help these smaller practices team up with larger organizations to establish more medical homes.

More than 50 percent of physicians and hospitals are looking at ways to team up, a trend that is causing medical malpractice concerns. Aon’s 12th annual Hospital and Physician Professional Liability Benchmark Analysis states that healthcare systems will face significant risk management challenges associated with integrated physician-hospital arrangements. The study details the growth of integrated self-insurance strategies and highlights the challenges faced by systems as they pursue the cost of risk savings.

And lastly, what are you doing to staunch the flow and expense of avoidable emergency department use? Describe your efforts in this area by October 31 and you will receive a free executive summary of results from this second annual survey. These stories and more in this week’s issue of Healthcare Business Weekly Update.

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