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CMS Issues Proposed Regulations for Accountable Care Organizations (ACOs)PINECREST, FL, March 31, 2011 - On Thursday, CMS issued proposed regulations that govern structure and processes for Accountable Care Organizations (ACOs) within the Medicare program. CMS estimates that up to 5 million Medicare beneficiaries may enroll in ACOs. Enrollment will only be open to beneficiaries of "traditional" Medicare, and not to Medicare Advantage members. Providers belonging to ACOs will continue to be reimbursed under Medicare's fee-for-service model. Additionally, ACOs will receive a bonus or be penalized for achieving or failing to achieve individual ACO benchmarks.
All ACOs will be expected to enter a three-year agreement with CMS. Under the terms of the agreement, ACOs will be required to have a formal operating structure in place, and will be assigned individual Tax Identification Numbers. Each ACO will be required to staff sufficient primary care practitioners to handle 5,000 beneficiaries.
A total of 65 quality measures encompassing 5 general areas will form the core quality benchmarks that ACOs will be expected to achieve. ACOs that meet the required quality benchmarks and targeted spending goals will be eligible for shared savings with Medicare. These spending goals will be determined by CMS for individual ACOs, with adjustments based on the characteristics of the beneficiary population. Public comments will be accepted for 60 days following publication of the proposed regulations.
Click here to view the proposed regulations. If you have any questions about the proposed regulations and how they may influence you and your practice, please call 888-568-4993.
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BSA Healthcare is a physician-owned healthcare consulting firm that helps hospitals, academic medical centers, private medical practices, and outpatient facilities improve quality, financial performance, operations, organizational structure, and strategic direction. Visit www.bsahealthcare.com or call 1-888-568-4993.
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