65 Medicare Accountable Care Organizations In Operation As of April 1, 2012
Open Minds May 21, 2012
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On April 10, 2012, the federal Centers for Medicare and Medicaid Services (CMS) announced it had selected a 27 organizations to participate in the Medicare Shared Savings Program payment reform demonstration, making a total of 65 accountable care organizations (ACOs) selected since January 2012. The selected ACOs will serve more than 1.1 million fee-for-service Medicare beneficiaries. The number of ACOs will increase in July 1, 2012 and again in January 2012. CMS is currently reviewing more than 150 applications from ACOs seeking to participate in the Shared Savings Program beginning July 1, 2012. CMS will accept applications from more potential ACOs in August 2012 for a January 2013 start date.
The 65 ACOs are testing diverse care coordination and reimbursement structures, as follows:
- 32 Pioneer ACOs started in January 2012; they serve an estimated 860,000 beneficiaries in 18 states. The program was designed for early adopters of coordinated care and is no longer accepting applications. More information is available athttp://innovations.cms.gov/initiatives/aco/pioneer/.
- 6 Physician Group Practice Transition Demonstration organizations started in January 2011; they serve an estimated 220,000 beneficiaries in 6 states.
- 27 Medicare Shared Savings Program ACOs started in April 2012; they will serve an estimated 375,000 beneficiaries in 18 states. More information is available at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html?redirect=/sharedsavingsprogram.
Five of the 65 ACOs are participating in the Advance Payment Model. Under this model they will receive three types of payment-two are upfront and one and are at-risk of loss if the ACO fails to complete the full initial agreement period of the Shared Savings Program:
- An upfront, fixed payment: Each ACO will receive a fixed payment that can be used to help build the necessary care coordination infrastructure, and can cover the cost of new staff or information technology systems. This must be repaid from shared savings earned by the ACO.
- An upfront, variable payment: Each ACO will receive a payment based on the number of its historically-assigned beneficiaries. This must be repaid from shared savings earned by the ACO.
- A monthly payment of varying amount depending on the size of the ACO: Each ACO will receive a monthly payment based on the number of its historically-assigned beneficiaries.
Only two types of ACOs can participate in the Advance Payment Model:
- ACOs that do not include any inpatient facilities and have less than $50 million in total annual revenue.
- ACOs in which the only inpatient facilities are critical access hospitals and/or Medicare low-volume rural hospitals and have less than $80 million in total annual revenue.
Eligible organizations interested in participating in the Advance Payment Model were required to apply to both the Medicare Shared Savings Program and Advance Payment Model and to enter the Medicare Shared Savings Program in April 2012 or July 2012. As of May 15, 2012, CMS was still reviewing 50 more applications for the program and had not announced the organizations participating in the Advance Payment Model beginning July 1, 2012.
To ensure that savings are achieved through improving and providing care that is appropriate, safe, and timely, all ACOs must meet quality standards. For 2012, CMS has established 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and the patient and caregiver experience of care.
Participation in an ACO is voluntary for provider organizations, and Medicare beneficiaries retain their ability to seek treatment from any provider organization they wish.
A link to the full text of “Medicare Shared Savings Program Accountable Care Organizations: Contact Information” may be found in The OPEN MINDS Circle Library at www.openminds.com/library/041012strat27acocontactinfo.htm.
A link to the full text of “Medicare Learning Network: Accountable Care Organizations: What Providers Need to Know” may be found in The OPEN MINDS Circle Library at www.openminds.com/library/101511stratacoproviderfaq.htm.
For more information, contact: Office of External Affairs, Centers for Medicare and Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244; 202-690-6145; Fax: 202-690-7159; Web site: www.cms.hhs.gov.
65 Medicare Accountable Care Organizations In Operation As of April 1, 2012. (2012, May 21). OPEN MINDS Weekly News Wire.
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