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Home Care Heroes Blog

ACO's - Final Regulation​s Issued: Home Care Coordination Needed

Elizabeth Hogue has shared with us a nice summary of the final regulations defining Accountable Care Organizations (ACOs).  We include her write-up in its entirety below.  The piece that gets us most excited at Ankota is found in the fine print towards the end of the summary.  It's the part that describes the need for ACOs to Coordinate Care.

  • ACO’s must put clinical and administrative systems in place and define processes to promote evidence-based medicine and patient engagement, to report on quality and cost measures, and to coordinate care.

We look forward to helping!

Elizabeth Hogue Esq.

Accountable Care Organizations (ACO’s) – Final Regulations Issued

Elizabeth E. Hogue, Esq.

Office:  877-871-4062

Fax:  877-871-9739

E-mail: ElizabethHogue@ElizabethHogue.net

Section 302 of the Affordable Care Act (ACA) includes provisions related to Medicare payments to providers of services and suppliers that participate in Accountable Care Organizations (ACO’s).  Providers of services and suppliers who participate in ACO’s will continue to receive payments under Parts A and B of the Medicare Program, but will also be eligible for additional payments if they meet certain requirements related to quality of care and cost savings.  Proposed regulations to implement these provisions were published in the Federal Register on April 7, 2011.  

Final regulations have now been released and will be published in the Federal Register soon.  The first agreements with ACO’s will take effect on April 1, 2012.  The final regulations generally provide as follows:

  • The ultimate goal of ACO’s is to reward better value, outcomes, and innovations instead of just volume.
  • The purposes of ACO’s are to:         
    • Promote accountability for a patient population,         
    • Coordinate items and services under Parts A and B of the Medicare Program, and         
    • Encourage investment in infrastructure and redesigned care processes for high quality and efficient service delivery.
  • A key concept of ACO’s is the “three-part aim” that includes:-         
    • Better care for individuals,
    • Better health for populations, and
    • Lower growth in expenditures.
  • Groups of providers of services and suppliers that meet criteria specified by the Secretary may work together to manage and coordinate care for Medicare fee-for-service beneficiaries through ACO’s.  ACO’s that meet quality performance standards established by the Secretary will be eligible to receive payments for “shared savings.”
  • The following types of providers are eligible to participate in ACO’s:         
    • ACO professionals in group practice arrangements (ACOHealthcare Reform professionals include physicians, physicians’ assistants (PA’s), nurse practitioners (NP’s), and clinical nurse specialists.)         
    • Networks of individual practices of ACO professionals         
    • Partnerships or joint venture arrangements between hospitals and ACO professionals
    • Such other groups of providers of services and suppliers as the Secretary determines appropriate
  • Eligible groups of providers of services and suppliers must meet the following requirements in order to participate in ACO’s:
    • ACO’s must be willing to become accountable for the quality, cost, and overall care of at least 5,000 Medicare fee-for-service (FFS) beneficiaries assigned to it.
    • ACO’s must enter into agreements with the Secretary to participate in the program for at least three years.
    • ACO’s must have formal legal structures that allow receipt and distribution of payments for shared savings to participating providers of services and suppliers.
    • ACO’s must include primary care ACO professionals that are sufficient for the number of Medicare beneficiaries assigned to the ACO and ACO’s must provide the Secretary with information about participating ACO professionals.
    • ACO’s must put clinical and administrative systems in place and define processes to promote evidence-based medicine and patient engagement, to report on quality and cost measures, and to coordinate care.
    • ACO’s must demonstrate to the Secretary that they meet criteria related to “patient-centeredness,” such as the use of patient and caregiver assessments and individualized care plans.
  • Reports related to quality must address care transitions across health care settings, including post-hospital discharge planning and follow up by ACO professionals.
  • ACO’s may also be responsible for excess expenditures. 

More to come on ACO’s; including tax, antitrust, fraud and abuse, and patients’ right to freedom of choice!    

© 2011 Elizabeth E. Hogue, Esq.  All rights reserved.

Ankota provides software to improve the delivery of care outside the hospital.  Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care.  To learn more, please visit www.ankota.com or contact Ankota

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