tci Medicare Compliance & Reimbursement - 2011 Issue 9
Accountable Care Organizations: CMS Outlines How Joining An ACO Will Benefit Practices, Beneficiaries
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Article Overview
This article covers CMS’s proposed Accountable Care Organization (ACO) shared savings program and how it is expected to shape participation by health care providers and Medicare beneficiaries. It discusses the program’s broad structure, the general concepts behind one-sided and two-sided models, the quality measurement framework, and the CMS rulemaking process. It is relevant for providers, practice administrators, and coding or compliance professionals who want a high-level understanding of Medicare payment policy changes tied to coordinated care.
Why This Topic Matters
The article matters because it summarizes an early Medicare payment reform initiative that links reimbursement to care coordination, patient outcomes, and performance measurement. It helps readers understand the policy context for ACO participation and the broader direction of CMS value-based payment programs.
Article Sections
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Overview of the shared savings program
Introduces CMS’s proposed ACO initiative and its purpose within Medicare payment reform. Describes the general aim of coordinated care and cost reduction.
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How ACO participation is structured
Explains the basic role of ACO participants and the kinds of provider groups involved. Covers the overall framework for provider participation and shared savings.
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One-sided and two-sided models
Summarizes the article’s discussion of the two model types included in the proposed program. Notes the broad distinction between savings-only and savings-and-risk arrangements.
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Quality performance standards
Describes the quality measurement framework used in the program. Identifies the general categories of performance standards referenced in the article.
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Comment period and CMS resources
Provides the article’s closing information on submitting comments and finding additional CMS program information. Includes references to the Federal Register and CMS public resources.
What You Will Learn
- The purpose of CMS’s proposed ACO shared savings program
- How the article describes provider participation in accountable care organizations
- The general difference between the program’s savings-only and savings-and-risk models
- The role of quality performance measures in determining participation outcomes
- How CMS public comment and program information are addressed in the article
Who Should Read This
- Physicians
- Hospital administrators
- Practice managers
- Compliance professionals
- Medical coders
- Revenue cycle staff
- Healthcare policy readers
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