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CMS Issues Final ACO Rules: Key Legal Implications for Hospital & Health System ACOs Print E-mail
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Friday, 19 June 2015 16:33

On June 4, 2015, the Centers for Medicare & Medicaid Services (CMS) released a final rule (Final Rule) containing changes to its Medicare Shared Savings Program (MSSP). These changes have important legal implications for accountable care organizations (ACOs), particularly those owned and operated by hospitals and health systems.

In many respects, the primary focus of the Final Rule is to make changes designed to ensure continued robust participation in the MSSP. Under the previous rule, an ACO was permitted to participate in Track 1 (with shared savings potential, but no risk for losses) for only the initial three-year agreement period. After the initial three-year period, ACOs were required to move to Track 2 (which includes down-side risk for losses). Without the changes adopted in the Final Rule, CMS estimated that fewer than 15 percent of ACOs would opt for continued participation under downside risk in Track 2. Under the Final Rule, ACOs can renew in Track 1. At the same time, CMS has made changes to Track 2, and created a new Track 3, to incentivize ACOs to move to a two-sided performance-based track. Under Track 2, ACOs will now have a choice among several options for their applicable minimum savings rate and minimum loss rate, allowing ACOs to more closely tailor Track 2 to their individual risk tolerance. In addition, the Final Rule creates a Track 3, which incorporates a higher shared percentage (75 percent), prospective assignment of Medicare beneficiaries, and the opportunity for a programmatic waiver of the three-day skilled nursing facility (SNF) rule (which permits payment for otherwise covered SNF services when a beneficiary is admitted to a SNF without a prior 3-day inpatient stay).

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Last Updated on Wednesday, 01 July 2015 15:47
Feds, state investigating St. Mary's pediatric heart surgery unit Print E-mail
Written by John Pacenti | Palm Beach Post   
Friday, 12 June 2015 17:03

The microscope on <West Palm Beach based> St. Mary's Medical Center's pediatric cardiac surgery program tightened its focus on Friday <6.5.15> with federal and state agencies saying they are investigating nine infant deaths at the hospital.

The federal Centers for Medicare & Medicaid Services said it was launching an investigation after CNN reported on Monday <6.1.15> that the mortality rate at St. Mary's 4-year-old program dwarfed the national average.

"We take these allegations very seriously. CMS is actively investigating these complaints," CMS spokesman Aaron Albright said.
CMS Releases Broad Data on Prescribing Patterns of Physicians & Providers Under Medicare Part D Print E-mail
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Friday, 22 May 2015 17:13

In a highly anticipated and scrutinized decision, the Centers for Medicare & Medicaid Services (CMS) released a new public data set on April 30, 2015, that includes detailed data regarding the prescribing patterns of physicians and other health care providers under the Medicare Part D Prescription Drug Program. Referred to as the Provider Utilization and Payment Data: Part D Prescriber Public Use File, the file comprises data relating to more than one million health care providers that prescribed $103 billion in prescription drugs across 36 million Medicare beneficiaries under the Part D program in 2013 (the Data Set). The decision reflects a growing effort by CMS to use data sharing to promote transparency and innovation, but users should be mindful of the context and limitations of the data, as cautioned by CMS.

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Last Updated on Saturday, 23 May 2015 09:28
CMS to Host Call re Hospital Inpatient Quality Reporting and Value-Based Purchasing Programs Print E-mail
Written by Jeff Cohen | Florida Healthcare Law Firm Blog   
Tuesday, 12 May 2015 11:03

CMS is hosting a call on May 12, 2015 to provide an overview of all Hospital Inpatient Quality Reporting and Value-Based Purchasing Programs.  The agenda items include...

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MEDCAC Meeting 7/22/2015 - Lower Extremity Peripheral Artery Disease Print E-mail
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Tuesday, 05 May 2015 10:18

On July 22, 2015, the Centers for Medicare & Medicaid Services (CMS) will convene a panel of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC). The MEDCAC panel will examine the scientific evidence of existing interventions that aim to improve health outcomes in the Medicare population, and address areas where evidence gaps exist, related to lower extremity peripheral artery disease (PAD). For purposes of this MEDCAC, we will focus on three categories along the disease progression continuum (asymptomatic, intermittent claudication, and critical limb ischemia).

Clinical outcomes of interest to the Medicare program include reduction in pain; avoidance of amputation; improvement in quality of life and/or functional capacity including walking distance; wound healing; avoidance of cardiovascular events, including myocardial infarction, stroke, cardiovascular death, and all-cause mortality; and avoidance of harms from the interventions. By voting on specific questions, and by their discussions, MEDCAC panel members will advise CMS about the extent to which it may wish to use existing evidence as the basis for any future determinations about Medicare coverage for interventions related to lower extremity peripheral artery disease. MEDCAC panels do not make coverage determinations, but CMS often benefits from their advice.

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