physicians to reduce medically unnecessary services. Section 512(b) calls for the report to Congress regarding options for further amendments to permit gainsharing that improve care
while reducing waste and increasing efficiency. Such further amendments, depending on their scope, could be particularly useful to ACOs in the commercial market that do not benefit from
the current waivers to certain of the fraud and abuse rules that are applicable to Medicare ACOs only. As with all such regulatory guidance, however, I would expect any further exceptions or safe harbors to the fraud and abuse rules to be quite narrow, leaving continued challenges in interpretation and uncertainty as to compliance in real world applications. Nevertheless, continued attention by the regulators to these challenges and their attempts to update their enforcement protocols to address changing circumstances is a good thing."
-Douglas A. Hastings, JD, Chair Emeritus, Epstein Becker & Green, PC
The Center for Medicare and Medicaid Services’ “waste reduction”
pilot with 58 ACOs—the Medicare Shared Savings Program—saved $705
million during its first year of ACO implementation while improving on
30 of 33 quality measures.
Excerpted from:
Accountable Care News, Volume 6 Number 5, May 2015, Editor's Corner:
"The New Center of Gravity in Healthcare: PCMH-Powered Family
Physicians. "
Becker's Hospital Review, May 11, 2015
Healthcare Finance News, May 7, 2015
The Journal of the American Medical Association (JAMA), May 4, 2015
Healthcare IT News, April 24, 2015
American Journal of Managed Care, April 21, 2015
Health Affairs Blog, April 17, 2015
The New England Journal of Medicine, April 15, 2015
- The CMS Next Generation ACO Model – Will It Increase Medical Malpractice Risk? by Susan Huntington
- Challenges with Measuring Savings in Shared Savings Arrangements by Jill Herbold, FSA, MAAA and Anders Larson, FSA, MAAA
- Editor’s Corner: Dave Ehrenberger, MD on PCMH-Powered Family Physicians
- Effective Population Health Management Delivers Sustained Medicare Star Improvement by Saeed Aminzadeh
- Thought Leader’s Corner: "Could Section 512 of the legislation repealing the SGR be a big deal for ACOs? How might it affect CMS revenue paid to ACOs? How would you amend the rules?”
- Industry News with briefs regarding Health Affairs, the New England Journal of Medicine, Journal of the American Medical Association, and CMMI.
- Catching Up with….Tricia McGinnis, MPP, MPH
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