Accountable Care Bulletin
  Complimentary from the publishers of Accountable Care News               May, 2015  
Capital BlueCross Accountable Care Arrangements: A Regional Health Plan's ACO Approach
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  “Section 512 is additional evidence that the message is getting across to Congress that fraud and abuse laws now on the books need to be further reconciled with the move to value-based payments. Section 512 (a) is immediately helpful by amending the Civil Money Penalty Statute to lessen the absurd possibility that a hospital would be penalized for gainsharing with
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. "

What's News
  12 recent accountable care, shared savings agreements
Becker's Hospital Review, May 11, 2015
Supply chain collaboration tested as more accountable care organizations form
Healthcare Finance News, May 7, 2015
  Association of Pioneer Accountable Care Organizations vs Traditional Medicare Fee for Service With Spending, Utilization, and Patient Experience
The Journal of the American Medical Association (JAMA), May 4, 2015
No ACOs without coordination
Healthcare IT News, April 24, 2015
The Role of Palliative Care in Accountable Care Organizations
American Journal of Managed Care, April 21, 2015
Structuring Physician Leadership To Promote Accountable Care
Health Affairs Blog, April 17, 2015
  Performance Differences in Year 1 of Pioneer Accountable Care Organizations
The New England Journal of Medicine, April 15, 2015
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This Month in Accountable Care News
  • 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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