Tag Archives: accountable care organization

ACO Details Are Out: The Policy & Practice Podcast

After much anticipation, the Centers for Medicare and Medicaid Services finally released the final rule on accountable care organizations. As physician and hospital groups were initially wary of ACOs, CMS said they’ve considered the suggestions and the rule was adjusted accordingly. Among other changes, interested physicians will now have more time to get an  ACO up and running.

Dr. Don Berwick discusses the future of Medicare. Courtesy the Bipartisan Policy Center

Meanwhile, other parts of the new health law haven’t has the same success. The administration has cancelled CLASS, the law’s long-term insurance program, calling if financially unsustainable.

The decision has given GOP lawmakers ammunition for arguments against the ACA.

For details on that and much more, listen to this week’s Policy & Practice Podcast.

–Frances Correa (@FMCReporting)


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Help Is on the Way for Primary Care Doctors (Wink, Wink)

Help is on the way “very soon” for family physicians, internists, and pediatricians in the form of a final rule for accountable care organizations (ACOs).

Based on extensive feedback on the proposed ACO rule, changes are coming that primary care physicians are going to like, Dr. Nancy Nielsen said.

The preliminary  rule  “was met with – how shall I say? – an underwhelming response by the medical community,” said Dr. Nielsen, Senior Advisor of the Center for Medicare & Medicaid Innovation established as part of Centers for Medicare and Medicaid Services (CMS) by the Affordable Care Act.

“We have a few code words we have to work out here so I don’t get into trouble, but you get what I am trying to say,” Dr. Nielsen said at the American Academy of Family Physicians Congress of Delegates. For example, if I tell you ‘it has been suggested to us,’ that is REALLY important and it may be coming out, but I can’t announce anything yet,” said Dr. Nielsen, an internist and former president of the American Medical Association.

Regarding ACOs, Dr. Nielsen said, “Very soon the final rule will come out. Very soon. CMS has listened to the feedback:”

“It has been suggested to us that 65 quality measures are way too many.”

“It has been suggested to us that the mechanism for the shared savings ought to be done differently.”

“And it clearly has been suggested to us that hospitals have the ability to come up with the capital to start an ACO, but it’s really tough for doctors. So it has been suggested to us that we give advanced payment. I am here to say that very soon you will see that, and very soon you will like what you see.”

Although doctors have always been accountable for the care of patients, now they also will be accountable for resource expenditures, and the Center for Medicare & Medicaid Innovation plans to help, Dr. Nielsen said. There will be new expectations and new tools given to primary care physicians. “I will tell you that never once in my 23 years of practice did I see data showing me what it cost when I ordered an x-ray. Do you know what it costs when you write a prescription for an antibiotic? Do you get that data? No, you have never seen that.”

“But you must help us achieve this … when the [internal] warfare within the house of medicine begins,” Dr. Nielsen said. “I have a pet peeve. It really makes me crazy when people talk about people who do primary care as ‘primary care physicians’ and all the other docs as ‘specialists.’” She said that family physicians, internists, and pediatricians should stand together and say ‘We are specialists, just like you are specialists. We have a critical role to play and we need to have the tools to help us play that role.”

“Stay tuned. A lot of things you are going to, like, have been suggested to us.”

Dr. Nielsen’s comments were streamed live on the Internet during the congress and are available as archived video.

–Damian McNamara

@MedReporter on Twitter

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Filed under Blognosis, Family Medicine, IMNG, Internal Medicine, Pediatrics, Physician Reimbursement, Practice Trends

Court Tackles Individual Mandate: The Policy & Practice Podcast

The Affordable Care Act faced its third appeals court challenge, the biggest and most important to date. This case, brought by 26 states,  centers around the constitutionality of the individual mandate, as well as the massive expansion of Medicaid. The judges in the case  didn’t seem persuaded to toss the law or deem its mandate unconstitutional, at least according to experts who observed the oral arguments in Atlanta. However, a final ruling is not expected for several months.

Photo courtesy of iStock

And physicans and hospitals aren’t biting when it comes to the Pioneer model for Accountable Care Organizations (ACOs). The Pioneer program, which has been offered as a sort of olive branch to health care providers unhappy with the proposed ACO rules, presents a fast track  to Medicare shared savings for those who are already functioning under a coordinated care system. Medicare officials extended the deadline for applying to Pioneer by about a month — most likely prompted by the negative feedback on the ACO proposal.

And a plus in this week’s edition: We preview the upcoming annual House of Delegates meeting of the American Medical Association.  Take a listen to the Policy & Practice podcast.

— Frances Correa (on Twitter @FMCReporting)

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Filed under Health Policy, health reform, IMNG, Internal Medicine, Podcast

SGR: The Three Most-Hated Letters in Medicine –The Policy & Practice Podcast

Most physicians would be happy if they never had to read, hear about, or discuss Medicare’s Sustainable Growth Rate, or “SGR” ever again. Alas, it looks like years of attempts to get rid of that formula, which dictates physician fees for Medicare, have come to naught yet again.

Courtesy of Ohio AFL-CIO Labor '08 Flickr Creative Commons stream

Congressional negotiators agreed last week to give physicians a reprieve from the 21% cut due to take effect on June 1, but instead of a replacement for the SGR, they simply said they’d punt on the issue for the next 3 years or so.

Physician groups and even the White House expressed exasperation, yet again, and it was all captured on this week’s installment of the Policy & Practice podcast.

Also included in our 3-minute rundown: a first look at the accountable care organization, or ACO.

Take a listen and let us know what you think:

—Alicia Ault (on Twitter @aliciaault)

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Filed under Health Policy, health reform, IMNG, Physician Reimbursement, Podcast