ACOs seek to remove “anomalous” spending from financial benchmark calculations

Medical Economics | April 30, 2024

A coalition of 11 groups representing accountable care organizations (ACOs) and other health care stakeholders wants the government not to consider “anomalous” Medicare spending that is outside ACOs’ members control when determining if an ACO has exceeded its annual spending benchmarks In a letter to Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services (CMS), the coalition members acknowledged CMS’s recent efforts to promote value-based care. They added, however, that including unusually high claims penalizes ACOs and jeopardizes participation of doctors, medical practices, and other health care organizations in them.

Can ACOs Flex While Supporting Specialty Care?

Health Affairs | May 1, 2024

On March 19, 2024, the Centers for Medicare and Medicaid Services (CMS) announced a new voluntary model—the Accountable Care Organization (ACO) Primary Care Flex Model (ACO PC Flex Model)—which will test primary care capitation in CMS’s permanent ACO program, the Medicare Shared Savings Program (MSSP). Under the model, monthly prospective primary care payments to MSSP ACOs will replace fee-for-service payments to primary care providers. The MSSP ACOs will, in turn, be responsible for distributing payments to primary care participants. The model aims to improve the predictability of primary care revenue and incent enhanced primary care services not covered under fee-for-service. Here, we discuss the model, the restrictions on participation, and how these factors may impact the ACO market.

‘Like peering through fog without a compass’: Value-based care’s future in orthopedics

Becker's ASC Review | April 26, 2024

Valued-based care has become a household name in healthcare.

Philip Louie, MD, a spine surgeon at Virginia Mason Franciscan Health in Tacoma, Wash., connected with Becker’s to answer, “What is the future like for value-based care in orthopedics?” (Note: This response has been lightly edited for length and clarity.) Dr. Philip Louie: Very complicated, like peering through fog without a compass. Value-based care, in its most basic form, is founded on a simple equation [value = quality/cost], with value being the highest priority of orthopedic care. The initial wave was full of momentum and fanfare supporting the transition from the long-standing model of fee-for services to a value-based care model, in which reimbursements would follow outcomes, rather than volume.

Choosing the Right QPP Reporting Method for MSSP ACOs in 2025

MRO | May 1, 2024

As the 2024 performance year ends, MSSP ACOs (Medicare Shared Savings Program Accountable Care Organizations) are bracing for new reporting obligations under the Quality Payment Program (QPP). The Centers for Medicare and Medicaid Services (CMS) is gearing up for a complete transition to digital quality measurement in 2025, mandating organizations to extract data from their practices’ certified EHRs (CEHRT). This transition comes in the form of the APM Performance Pathway (APP), the latest CMS reporting method tailored for MIPS (Merit based Incentive Payment System) Alternative Payment Models (APMs) and ACOs, effectively replacing the CMS Web Interface. While the move promises a more streamlined reporting system, it presents challenges, particularly for ACOs unprepared for the conclusion of the Web Interface era.