Healthcare Experts Weigh In On ACO’s

By Karen Minich-Pourshadi, for HealthLeaders Media 

If you feel as though just about every week or so something new comes out involving accountable care organizations, you’re not mistaken. The Centers for Medicare & Medicaid Services recently announced two initiatives related to the ACO model: The ACO Pioneer Program and the Advanced Payment Initiative. So, what do these two programs mean for hospitals and health systems? Well that depends on your thoughts on ACOs, and more than a few experts, including the two I spoke with, disagree.

First, the lowdown on the latest programs:

The ACO Pioneer Program: Launching in fall 2011, the ACO Pioneer Program allows 30 organizations, or “Pioneers,” to more rapidly move from a shared savings payment model to a population-based payment model “on a track consistent with, but separate from, the Medicare Shared Savings Program,” according to the CMS Center for Medicare & Medicaid Innovation.

The program is designed to:
  • work in coordination with private payers by aligning provider incentives
  • achieve cost savings for Medicare, employers and patients

For the first two years of the Pioneer program, the payment models being tested are a shared savings payment policy with generally higher levels of shared savings and risk than those currently proposed in the Medicare Shared Savings Program. In the third year of the program, participating ACOs showing specified levels of savings over the first two years will be eligible to move a substantial portion of their payments to a population-based model.

Advanced Payment Initiative: Also launching in the autumn, the….

For complete article, click here.

Karen Minich-Pourshadi is a Senior Editor with HealthLeaders Media. She may be reached at kminich-pourshadi@healthleadersmedia.com.

CMS Announces Request for Applications on ACO ‘Pioneer Program’ and More..

Just off the phone listening to Drs. Berwick, Gilfillan, and Jonathan Blum CMS conference call on ACO’s. According to CMS, the call replay is available ‘for the next two days’, via: 800.837.1935, use code: 68658167, held on 5/17/at 11 1:30 ET. 

We’ve recorded the session and it will be available via ACO Watch: A Mid-Week Review as well [Program note, the audio is not the best, so your first choice is to listen by dialing the phone number above].

To access the filed document with the Office of the Federal Register, click here.

The original press release announcing the three CMS initiatives can be found here.

The CMS announcement is quoted in part below:

Organizations interested in applying to the Pioneer ACO Model must submit a letter of intent on or before June 10, 2011.  Applications must be received on or before July 18, 2011.  The Pioneer ACO Request for Application, the Letter of Intent form and the Application form  may be accessed at http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/pioneer-aco.  The Innovation Center will hold an Open Door Forum to review the Pioneer ACO Model Request for Application on June 7, 2011.

More information about the Advance Payment ACO Model can be found at: http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/advance-payment/.  The Innovation Center will accept comments on the Advance Payment ACO Model, if submitted prior to June 17, 2011.  Comments should be submitted via email to:  advpayACO@cms.hhs.gov.

Individuals wishing to attend the June Accelerated Development Learning Session in person may register at https://acoregister.rti.org. Registration is on a first come, first served basis.

More information about the Medicare Shared Savings Program can be found at:  http://www.cms.gov/sharedsavingsprogram/.  The Medicare Shared Savings Program proposed rule can be downloaded at: http://edocket.access.gpo.gov/2011/pdf/2011-7880.pdf .  Comments on the proposed rule, which can be submitted electronically to www.regulations.gov, must be received by June 6, 2012.

The ‘ACO Sentiment Index’: A Tipping Point In Sight?

It’s been some 47 days (and counting) since CMS released the Notice of Proposed Rule on Accountable Care Organizations. Initial reaction was somewhat subdued, given its inherent complexity. Yet recently it seems CMS’s likely surviving allies may be patient advocates, Medicare beneficiaries and the patchwork of provider culture associated with Federal program funding, as well as those tethered to or counting on the range of programs empowered by the Center for Medicare and Medicaid Innovation (CMMI).

Most recently that prevailing hedged if not ‘bearish sentiment’ was captured and parsed in a report compiled by HealthLeaders, perhaps best reflected in the lead quote from Chris Van Gorder, President and CEO, Scripps Health:

“Frankly, I was surprised. I thought there would be more carrots, not so much stick.”

Let’s back up a tad and re-set the context for this piece by recalling the ‘ACO Basics’ per recent preso compiled by Navigant, titled: ACO Proposed Regulations: Implications for Payers & Providers. In summary:

  • CMS issued proposed rules for Medicare ACOs on 3/31/11 and is actively soliciting comments until June 6th, 2011.
  • ACO refers to a group of providers and suppliers of services (e.g., hospitals, physicians, suppliers) that will work together to coordinate care for Medicare Part A & B patients.
  • Implementation goal is January 1, 2012 (phase 1) and potentially July 1, 2012 (phase 2).
  • Provider participation is voluntary; 5,000 patients minimum; 3-year contract between ACO & CMS; beneficiaries do not enroll in an ACO per se.
  • CMS still reimburses FFS; CMS also develops benchmark against which ACO performance is measured to assess whether ACO qualifies for additional shared savings or is accountable for shared losses; 2 possible risk arrangement tracks.
  • Extensive patient-centered criteria to demonstrate, i.e., Data reporting capabilities in place, Patient on the governing board, Systems to identify high-risk individuals, Processes for individualized care plans, Mechanisms for coordination of care (e.g., care coordinators) and Electronic exchange,  summary of care in care transitions
Worthy goals and ambitions any reasoned  health care stakeholder would not likely oppose, yet perhaps reflected best by Andy Slavitt, CEO of Ingenix (Editors Note: ‘hedging’ duly noted in the whitespace.)
“In the short-term, the ACO proposed rules will create a framework for the industry to start to transition from silos to a well-coordinated and aligned system.”

The Health Leaders report further notes:

Industry leaders expect the regulations will be modified once CMS hears the volume of concerns during the comment period. And in the meantime, healthcare leaders are trying to do what the federal government wants in the long run, which is to cut costs, become more efficient and streamlined, and make tweaks or even massive changes in their systems to better manage all aspects of care for their patients.

To download and read the complete article, click here.

I may be reading too much into the buzz at the moment, but if you add up the documented concerns of industry leadership (both payor and provider verticals), you basically get the message of an industry saying ‘yes, but’. Yes, we agree with the ends, but at the moment we’re not quite convince by the ‘over-reach’ of the means. It’s perhaps the definition of ‘over-reach’ which seems to vary by camp that may be worthy of separate consideration. More later.

Meanwhile, today at 1:30 PM Eastern, CMS holds another listening session and conference call, more on that in a separate post.

Vince Kuraitis: ‘Is Hospital-Physician Integration Sustainable?’

On the Wednesday May 11th 2011 broadcast, at 11AM Pacific/2PM Eastern, consultant, blogger, noted speaker, and soon to be published author, Vince Kuraitis is my special commentator on the always ‘tender’ subject of physician/hospital alignment. Given the current scramble to position traditionally independent, siloed or discontinuous provider relationships into a coordinated tapestry of ‘accountable care’ if not a ‘per se’ ACO, the question arises: Is the marriage of two often historically troubled allies even possible, or might their be a more suitably aligned partner(s)?

In a recent blog post at e-Care Management Blog several noted thought leaders (including former guest commentator William DeMarco) chime in on the subject, see: ‘Is Hospital-Physician Integration Sustainable?‘

Join us!

Top Pick’s in the ‘ACO Tool Shed’

Since CMS released the NPRM in March 2011, we’ve witnessed a veritable onslaught of client briefings, and analysis pieces on Accountable Care Organizations and the Medicare Shared Savings Program. The ‘buzz’ is intense as we play out the comment period.

There is so much quality information readily available via Twitter, we thought it would be useful to capture and link to some of the more impressive works now available.

Here is our first installment of ‘Top Picks‘:

If you want your briefing, document or presentation considered for publication on ACO Watch, please @reply to @ACOwatch on Twitter.

Editor’s Note on #ACOchat

We missed our #ACOchat today due to other commitments and a full schedule. Our intention is for the ‘TweetChat to run on a weekly basis, with Tuesday at 3PM Eastern/12 Noon Pacific time as the preferred slot on the calendar. Though until we reach some community consensus or affirmation of the day, and time chosen, can remain somewhat flexible until we land of solid ground.

Meanwhile, I’ve been noticing the many resources specific to Accountable Care and ACO’s in particular that are being posted to Twitter almost daily, all of which are adding value to the emerging conversation.

As a reminder, we remain in the 60 day comment period of the notice of proposed rule issued by CMS on March 31st, 2011. Their release has stimulated quite a bit of conversation. For an overview of the Medicare Shared Savings Program, click here. To review the complete published rule and comment online before June 6th, 2011 deadline, click here.

In a separate post, I will list some of the more useful resources found on Twitter in the last week or so.

First ACOchat ‘In The Can’

On Tuesday, April 27th, with the able support and leadership of Mark Browne, MD, aka @consultdoc we experienced the first TweetChat focused on the Accountable Care Organization niche.

Many of our community members joined in and created a rich conversational stream around the three topics (T1, T2 & T3) generated for the moderated conversation, which included:

T1: Will ACO’s ultimately lead to any significant innovations in the world of healthcare?

T2: ACO’s have a large focus on primary care physicians. Will specialists be relegated to the role of ‘best vendor’?

T3: Telehealth is mentioned throughout the law, yet current regs are barriers to effective telemed? Can they be overcome?

For a complete transcript of the hour, click here, for a summary recap, click here (both courtesy of our friends at The Fox Group, LLC).

You may also visit ‘ACO Chat’ for a continuous loop of Tweets during the hour. ACOchat will convene for one hour weekly at 3PM Eastern and 12 Noon Pacific Time. Join us!

ACO Watch: A Mid-Week Review with Michael L. Millenson

On the Thursday, April 28th 2011 program at 11AM Pacific and 2PM Eastern, my guest commentator for an encore appearance is thought leader, author, blogger, lecturer and consultant on health care quality Michael L. Millenson. We’ll discuss his piece: ‘ACO Fairy Tale Faces a Rumpelstiltskin Moment‘ and more.

Millenson is president of Health Quality Advisors LLC, and a nationally recognized expert on improving the quality of American health care. He is the author of the critically acclaimed book, Demanding Medical Excellence: Doctors and Accountability in the Information Age, and he holds an adjunct appointment as the Mervin Shalowitz, M.D. Visiting Scholar at Northwestern University’s Kellogg School of Management.

For more information, click here.

Please join us!

ACO and Medicare Shared Savings CMS Listening Session | Region 10

CMS in its continuing commitment to be present and engage healthcare stakeholder voices in the complex challenge to re-engineer the complex and somewhat change resistant ‘healthcare borg’ (disclosure: editors words, not CMS) will hold another listening session on Thursday, April 28, 2011 from 9:30 AM – 11:30 AM (PT).

To register for the event via teleconference or attend in person at the Hilton Seattle Airport and Conference Center (details below), click here.

Hilton Seattle Airport & Conference Center, Crystal Ballroom 17620 International Blvd
Seattle, WA 98188-4001

The Region 10 Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) invites your participation in a Medicare Shared Savings Program Accountable Care Organization Listening Session co-hosted by HHS Regional Director Susan Johnson and CMS Regional Administrator John Hammarlund.

Jonathan Blum, CMS Deputy Administrator and Director of the Center for Medicare, will provide opening remarks and an introduction of the proposed new rule to help health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs).

ACOs create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities.  The Medicare Shared Savings Program will reward ACOs that improve or deliver high quality care and lower growth in health care costs while putting patients first.  Patient and provider participation in an ACO is purely voluntary.

The proposed new rule is now available for public comment.  This listening session is being held during the comment period to help the public understand what CMS is proposing to do and to ensure that the public understands how to participate in the formal comment process. CMS will respond to questions you may have on the proposed rule.  This listening session is not a forum for submitting formal comments on the notice of proposed rule.  

The proposed rule along with joint CMS/OIG notice are posted at: www.ofr.gov/inspection.aspx

Formal comments on the proposed rule will be accepted through Monday, June 6, 2011. CMS will respond to all comments in a final rule to be issued later this year.

A teleconference with a limited number of lines will be available for those who are unable to attend in person.  The teleconference will be listen-only.  Please register for “Teleconference attendance” as your ticket type in order to get information e-mailed to you on how to dial in to the teleconference.

Fairy Tales, ACOs and More with Michael L. Millenson

Michael L. Millenson, President of Health Quality Advisors LLC, joins me on ACO Watch: A Mid-Week Review, on April 28th, 2011 at 11AM Pacific and 2PM Eastern.

Millenson channels sentiments of the ‘bearish camp’ on ACO viability recently via a piece he authored titled “ACO Fairy Tale Faces a Rumpelstiltskin Moment‘. A portion of which is below:

The ACO fairy tale is drawing perilously close to an unhappy ending.

The government’s long-awaited draft regulations on Accountable Care Organizations have brought a dose of ugly reality to a concept that’s always seemed coated with a patina of pixie dust. Unless those regs are substantially changed before the clock strikes Jan. 1, 2012 — the statutory date for ACO implementation — Cinderella’s going to turn back into a scullery maid and the horse-drawn carriage transporting her to the Health System Transformation Ball will be revealed as nothing more than four mice and a pumpkin.

The essence of the ACO concept is using financial incentives to reward doctors and hospitals for redesigning care processes to provide “high quality and efficient service delivery,” in the words of the Patient Protection and Affordable Care Act. As I wrote last fall, ACOs have been the one reform beloved by Republicans and Democrats; doctor groups and insurance companies; policy wonks and profit-seeking capitalists. This unusual unanimity was due in part to a lack of specifics that enabled every stakeholder to gaze upon the ACO and see reflected their very own version of Prince Charming.

Conservatives hail the ACO as marketplace medicine, while liberals focus on organized systems of care replacing fee-for-service chaos. Providers applaud a reform that places them at its center, while health plans know that providers asked to bear financial risk — if an ACO doesn’t measure up, the government won’t pay up — will seek out actuarial experts like them as partners. ACOs also are expected to require the products and services sold by a host of consultants and entrepreneurs.

For medical groups and hospitals considering becoming an ACO, Medicare offers a straightforward risk-reward proposition. Providers must invest considerable resources in…. (read complete article, here).