ACO Update: Final Rules And “Pioneers”

CMS’s Final Rule On Medicare Shared Saving Program

Centre of Medicare & Medicaid Services (CMS) has recently issued final rules for implementing the “Shared Savings” program scheduled to start in 2012. This program awards accountable care organizations (ACOs) - integrated provider networks - with a portion of savings generated from more efficient care of assigned fee for service Medicare patients. Just prior to the end of the year, CMS announced the first group of “pioneer” ACOs which will be entitled to a greater share of savings and also be at greater risk if there are insufficient cost savings, as compared to other ACOs.

In the final rules, Medicare made a number of concessions to attract more interest among both small and large provider groups. Some changes were intended to lessen the financial and administrative burden of forming an ACO. Additional changes were intended to add more operational flexibility, such as allowing other physician specialties to have greater impact on ACO performance. As a result of the changes, it may be more feasible to either start a group from scratch or modify existing arrangements to qualify for
ACO status.

Although “pioneer” organizations are subject to slightly different requirements, there are lessons to be learned from the initial selection process. Sign Up with this 60 minute audio conference, where our expert speaker Wayne J. Miller will elucidate the characteristics of successful applicants that provides insight into what Medicare is seeking. And the submissions by unsuccessful applicants that highlights the hurdles that need to be overcome to be chosen.

Session will cover:

• What are the types of provider entities that can be ACOs
• Keys to success or rejection
• What are the minimum organizational, financial requirements
• Roles of primary and specialist providers in ACOs
• Getting enrollees and keeping them: what’s allowed and what isn’t
• Addressing fraud and abuse and Stark law issues
• Can you earn a bonus? Calculating the benchmark and savings

5 AHIMA CEUs Approved with this conference

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

Who should attend? hospitals clinics, practice managers, physicians, medical groups, and health care consultants

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