Accountable Care Organizations

On April 24-26, The National Association of Accountable Care Organizations held its semi-annual conference for members. NAACOS invites its business partner members, including Husch Blackwell, to attend their semi-annual meetings. Scott Loftin, a Healthcare Regulatory Associate in Husch Blackwell’s Denver office, and I were fortunate enough to attend the conference on behalf of the firm. This conference provided an opportunity for us to listen to the issues, challenges, concerns, and ideas ACO leadership are exploring and facing in today’s regulatory landscape. The presentations and conversations among the members provided us with a deeper understanding of our ACO clients’ business and legal needs.
Continue Reading Husch Blackwell at the NAACOS Conference

This is the second article in our series on the new “Pathways” rules for Accountable Care Organizations. Our first article in the series can be found here.

The Centers for Medicare and Medicaid Services (CMS) released a report on August 27, 2018, showing Next Generation accountable care organizations (ACOs) produced net savings of $62 million in 2016 while maintaining quality of care.  CMS Administrator Seema Verma pointed to the savings as evidence that ACOs taking two-sided risk succeed, according to a CMS press release. 
Continue Reading Performance Report: “Pathways” Rules Help CMS Advance Two-Sided Risk Sharing

A stethoscope and American money on a white background - HealthcEven without potential changes to the Medicare program, MACRA poses a significant challenge for any clinician trying to determine the best strategy to maximize Medicare reimbursement – there are hundreds of pages of guidance in the proposed and final regulations to review and understand. But, at this point, clinicians attempting to assess MACRA must also deal with uncertainty about changes to the Medicare program. A significant source of uncertainty is the Trump administration’s stated intent to repeal the Affordable Care Act (“ACA” and also known as Obamacare), which is being implemented by current legislative efforts. Uncertainty about the ACA should be considered in developing a strategy to comply with MACRA.
Continue Reading Managing MACRA – Part VII: What happens to MACRA if the Affordable Care Act is repealed?

A stethoscope and American money on a white background - HealthcAs of January 2016, there were 433 Medicare Shared Savings Program (MMSP) Accountable Care Organizations (ACOs) with almost 7.7 million assigned beneficiaries and more than 14,000 participants (a participant may be a group or an individual). Most of these ACOs are one-sided model ACOs that may generate shared savings and do not involve shared losses (Track 1 ACOs).

Importantly, Track 1 ACOs are not considered advanced alternative payment models (APMs) for purposes of MACRA. As a result, a clinician participating in a Track 1 ACO is subject to the merit-based incentive payment system (MIPS) just like a clinician that is not in an ACO (a participant in an advanced APM is not subject to MIPS).
Continue Reading Managing MACRA – Part V: What do I have to do if I’m in an ACO?

A stethoscope and American money on a white background - HealthcUnder MACRA, the merit-based incentive payment system (MIPS) automatically applies to eligible clinicians (generally a physician or mid-level – see our previous blog post for details) and most clinicians who treat Medicare patients are expected to be included in MIPS. As a result, one of the most common questions about MACRA is when it starts. CMS’s final MACRA rule confirms that implementation begins Jan. 1, 2017.
Continue Reading Managing MACRA – Part IV: When does it begin?

spotlightiStock_000001543068_LargeThe Office of the Inspector General (OIG) for the U.S. Department of Health & Human Services recently published its Fiscal Year 2016 Work Plan, which summarizes OIG’s priorities over the coming year. Notably, the 2016 Work Plan demonstrates the OIG’s expanded focus on delivery system reform and the effectiveness of alternate payment models, coordinated care programs, and value-based purchasing.

There were also noteworthy areas of new focus for several provider types, including skilled nursing facilities, hospice organizations, ambulatory surgical centers, and physician practices.  Below we have highlighted a few key areas from the FY 2016 Work Plan that will likely impact these providers. Please note this is not intended to be a comprehensive summary of the 2016 Work Plan and is focused only on the new OIG focal areas for these certain providers.
Continue Reading OIG issues FY 2016 Work Plan with more than 40 new focal areas

medicalequiptmentiStock_000013829082_LargeIn a 92-8 vote on April 14, 2015, the Senate passed a bipartisan measure to repeal the Medicare payment formula known as the Sustainable Growth Rate (“SGR”). The legislation also included a new payment system that rewards providers for the quality and efficiency of care they provide.
Continue Reading Value-based payments are heading for physicians

dollar-signiStock_000013001848_LargeThe DOL’s self-imposed February deadline for announcing new FLSA regulations redefining “white collar” exemptions has come and gone with without any action from the DOL. No new deadline has been announced; however, the DOL’s website suggests that it still hopes to release the new regulations soon. Stayed tuned, and we will report back when the