CMS Changes ACO Rules

After much criticism over the draft regulations on ACOs, CMS decided to change some items in the final rule that was issued last week. Some of the key areas that received complaints involved rewards, risk, quality measures, start-up costs, and identifying patients. CMS responded by changing the regulations in these areas.
Rewards: ACOs may now share savings earned from the start.
Risk: There is now no risk of financial penalties in one of two payment options.
Quality Measures: The number of measures has been reduced from 65 to 33.
Start-up Costs: Physician-owned and critical-access hospital ACOs can now get bonuses upfront.
Identifying Patients: CMS has decided to notify ACOs upfront (vice after the fact).

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Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

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Healthcare Reform Remains Until 2015?

Although many have argued against the constitutionality of the new healthcare reform law (and have had considerable successes), the winds of change may be halting temporarily.  The issue is that courts may not be able to rule on the law’s constitutionality until 2015! There is a federal law that bars most challenges to tax-related legislation before the tax or penalty is paid. Thus, even a conservative-leaning panel of federal appellate judges suggested the challenges to the new law may be premature.

So, we will all still await for the Supreme Court to weigh in.

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Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

SGR Repeal

The Medicare Payment Advisory Commission (MedPAC) voted today to approve a proposal to repeal the sustainable growth rate (SGR) formula which determines Medicare physician payments. Additionally, state medical associations such as the Florida Medical Association are pushing to repeal the badly flawed SGR.
In January 2012, the currently next scheduled SGR adjustment would impose a 30% cut in reimbursement to the Medicare Physician Fee Schedule. Today’s MedPAC vote was almost unanimous. But remember also that MedPAC’s recommendation targets specialists as a need to realign payments to support primary care physicians.

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Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.