Ken Perez
The SGR repeal legislation could kill the proverbial two birds with one stone, replacing once and for all the unpopular SGR, while also supporting the Department of Health and Human Services' push for fee for value in general and ACOs in particular.
The Next Generation ACO Model will test whether strong financial incentives, coupled with tools to help facilitate better patient engagement and care management, can improve health outcomes and reduce expenditures for Medicare beneficiaries.
HHS has, for the first time in the history of the Medicare program, set a goal of pushing a significantly larger share of Medicare payments through alternative payment models such as accountable care organizations (ACOs) and bundled payments.
This week CMS launched an ACO Investment Model, which will provide up to $114 million in upfront investments, to up to 75 Medicare Shared Savings Program ACOs. The program aims to help ACOs succeed in the MSSP by providing upfront capital to cover startup and ongoing infrastructure costs.
Hanging above physicians like the mythical sword of Damocles, the sustainable growth rate (SGR) provision threatens to impose a 24.4 percent decrease to the Medicare Physician Fee Schedule on Jan. 1, 2014.
Is it realistic to expect Accountable Care Organizations to achieve their cost-reduction targets in the first year of their programs? The experience of the original 32 Pioneer ACOs is suggestive.
One would think, given the title of the CMS press release, "Pioneer Accountable Care Organizations succeed in improving care, lowering costs," that the first year of the advanced ACO program was an across-the-board roaring success. But upon closer examination, the report card would appear to be rather checkered.
The recent New England Journal of Medicine article, “The ACO Model—A Three-Year Financial Loss?” by Trent T. Haywood and Keith C. Kosel, provides a financial analysis of the Physician Group Practice (PGP) Demonstration that the Centers for Medicare & Medicaid Services (CMS) conducted from 2005 to 2010.