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The ISMA represented you at CMS session on ACO rules
e-Reports, August 8, 2011
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The ISMA represented members at a recent provider forum to share physician concerns and offer suggestions about proposed rules for accountable care organizations (ACOs).

In attendance was Jonathan Blum, deputy administrator and director of the Centers for Medicare & Medicaid Services (CMS), and Richard Baron, M.D., a director at the Center for Medicare and Medicaid Innovation. Among the 50 representatives from the provider community in attendance, most were from hospitals and hospital systems.

A pre-set agenda was based on the most prominent areas of concern about ACOs, including how patients are attributed to ACOs, the 65 quality measures, share of savings and the downside risk (shared losses).

“The concerns expressed by the other attendees were very consistent with those of our ISMA ACO Task Force, which we submitted to CMS in writing in June,” said Julie Reed, ISMA general counsel, who represented the ISMA. “I also spoke privately with Mr. Blum and Dr. Baron to further convey our concerns and observations.”

CMS officials indicated they are under immense pressure “from above” to immediately reduce expenditures from the Medicare Trust Fund. This Shared Savings Program aspires to do that, but the rules proposed this spring elicited such widespread – and harsh – criticism, including from the ISMA, that they are now trying to craft more workable ones. Admittedly, officials are struggling to accomplish this, to determine which elements the program should include and which ones to phase-in gradually.

No timeline was provided, and final rules are not expected before fall; however, any results will need to be fast-tracked because officials still intend to roll out the Shared Savings Program in January, as set by Congress.

Forum attendees also had an opportunity to hear about activities of the Center for Medicare and Medicaid Innovation, tasked with developing new health care delivery and payment models. Concepts released so far have centered on various ACO initiatives, including advance payment models and the Pioneer ACO program. (Read more about this model on the CMS website and learn about ACOs on the ISMA ACO page.)

Separate sessions were planned for later in the day, one for payers and employers and another for the Indiana Health Information Exchange.

About accountable care organizations
Accountable care organizations (ACOs) are mechanisms for participating in the Medicare Shared Savings Program created through federal health care reform, the Patient Protection and Affordable Care Act. Health care providers collectively create separate entities, called ACOs, that can receive back a portion of the funds they save Medicare by yielding higher quality, lower cost services for defined populations of Medicare patients. Participation in ACOs is voluntary, but some physicians’ choices may be dictated by their affiliations with hospital systems.
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