From the Health and Human Services website:
“The 2006 Tax Relief and Health Care Act (TRHCA) required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries during the second half of 2007 (the 2007 reporting period). CMS named this program the Physician Quality Reporting Initiative (PQRI). The PQRI was further modified as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) In 2011, the program name was changed to Physician Quality Reporting System (Physician Quality Reporting).”
As part of the Patient Protection and Affordable Care Act (PPACA) of 2010, there are new compliance regulations aimed at combating fraud and abuse of Medicare and Medicaid programs. To assist doctors in getting ready for the new regulations, training conferences hosted by the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a combined effort by the Centers for Medicare and Medicaid Services, the Office of the Inspector General for Health and Human Services, and the Department of Justice are being held around the country. In the notes that HEAT provides for the conferences there are 10 tips to help doctors comply with the new regulations.
Come with me to the land of happy health reform. It is a place where Republicans and Democrats find common ground, a place where physicians, hospitals and health insurers sit together as partners, a place where criticism is respectful, not rancorous. It is the world of Accountable Care Organizations (ACOs).
What are ACOs, and why have they escaped the general onslaught of opprobrium from Obamacare opponents?
The term Accountable Care Organization was originated by Elliott Fisher of the Dartmouth Center for the Evaluative Clinical Sciences, picked up by the Medicare Payment Advisory Commission and then enshrined in Section 3022 of the Patient Protection and Affordable Care Act (otherwise known as health care reform). The language is explicitly designed to use financial incentives to change the health care delivery system.
Written by Roger Collier in The Health Care Blog
In addition to Medicare Advantage payment cuts and potential reductions in fee-for-service payment updates, PPACA includes various provisions intended to facilitate ongoing Medicare cost containment, notably creation of the Independent Payment Advisory Board and the Center for Medicare and Medicaid Innovation. In addition to CMI’s broad scope, PPACA requires specific pilot projects, including (in Section 3022) demonstration of accountable care organizations (ACOs).
There has been a lot of talk recently about outcome based healthcare coming out of
The Federal Trade Commission recently held a day-long workshop focusing on Accountable Care Organizations. ACOs will vertically integrate hospitals and doctors and, in the process, achieve what previous incarnations of vertical integration could not. Let’s forget about whether ACOs will actually fulfill the dream of efficient healthcare delivery and focus on the FTC angle – will the creation of ACOs require the creation of provider market power and should he FTC therefore look the other way?
Many health economists have documented the perils of provider market power. Some of my own research has been instrumental in turning the tide against providers, whose monopolizing tendencies used to get a free pass from the courts. But as policy makers move ACOs to the fore, providers are hoping to sweep antitrust under the rug.
“Great companies have high cultures of accountability, it comes with this culture of criticism I was talking about before, and I think our culture is strong on that.” – Steve Ballmer
“I am responsible. Although I may not be able to prevent the worst from happening, I am responsible for my attitude toward the inevitable misfortunes that darken life. Bad things do happen; how I respond to them defines my character and the quality of my life. I can choose to sit in perpetual sadness, immobilized by the gravity of my loss, or I can choose to rise from the pain and treasure the most precious gift I have – life itself.”
- Walter Anderson
“When it comes to privacy and accountability, people always demand the former for themselves and the latter for everyone else.” – David Brin
The requirements contained within the 492 page volume of regulations, which will govern Accountable Care Organizations (ACO’s), will create ‘significant barriers’ that will discourage the support of the concept of ACO’s. So says Delos Cosgrove, the CEO of the Cleveland Clinic, in an eight page letter to Donald Berwick, top administrator for the Center for Medicare and Medicaid Services (CMS). In his letter, posted by Modern Healthcare, Cosgrove claimed: “Rather than providing a broad framework that focuses on results as the key criteria for success, the proposed rules are replete with 1) prescriptive requirements that have little to do with outcomes, and 2) many detailed governance and reporting requirements that create significant administrative burdens,”
One of the ways that the Patient Protection and Affordable Care Act (PPACA) aims to reduce Medicare/Medicaid expenses is to utilize Accountable Care Organizations (ACO). An ACO is a group of doctors and hospitals that will share the responsibility for providing quality care to patients. Under the new law, an ACO would agree to manage all of the healthcare needs of a minimum of 5,000 Medicare recipients for a minimum of three years.