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December 23, 2011 - Advocacy Corner
Top News
House Agrees to Senate SGR and Payroll Tax Plan after Stalemate
After a highly contentious week of political back-and-forth, House Speaker John Boehner decided Thursday to reverse course
and hold a vote on a slightly tweaked version of the Senate's short-term extension of the Medicare pay patch, payroll tax
cut and unemployment insurance. The bill passed by unanimous consent in both the House of Representatives and Senate earlier
today. This means the Sustainable Growth Rate cut will be averted for two months, with another fight over the SGR and the
payroll tax relief looming in 60 days. In a press conference held this afternoon, President Obama thanked “all members of
Congress for ending the stalemate” on the payroll tax cut and urged lawmakers to “keep working without delay, without drama”
to get a full-year agreement after the holidays. Meanwhile, a wide assortment of physician groups coldly received the
short-term patch, urging Congress to pass a permanent fix early in 2012.
Administration
CMS Announces 32 Pioneer ACOs
The CMS Innovation Center announced this week agreements with thirty-two organizations
that will test new payment models for the care of Medicare beneficiaries. The Pioneer ACOs model was designed specifically for organizations with experience offering coordinated,
patient-centered care, and operating in ACO-like arrangements. The three year program will allow providers to test a shared savings and shared losses payment arrangement with
higher levels of reward and risk than in the CMS-ran Shared Savings Program. In year three of the program, those Pioneer ACOs that have shown savings over the first two years
will be eligible to move to a population-based payment model. Population-based payment is a per-beneficiary per month payment amount intended to replace some or all of the ACO’s
fee-for-service (FFS) payments with a prospective monthly payment. Similar to requirements under the CMS Shared Savings Program, Pioneer ACOs must attest and CMS will confirm
that at least 50 percent of the ACO’s primary care providers have met requirements for meaningful use of certified EHRs by the end of 2012. Similarly, the quality measures for
Pioneer ACOs mirror those in the Shared Savings Program.
According to the CMS Innovation Center, Pioneer ACO applicants sought flexibility in the core payment arrangement described above. CMS identified the
major themes (.pdf) in applicants’ suggestions and
offered two alternative payment arrangements to address those suggestions:
- Some applicants wanted to bear less financial risk in the first year, but sought to have risk accelerate in later years; and,
- Other applicants wanted to bear more risk and/or receive more population-based payment than in the Core Payment Arrangement.
Of note to CHIME members is that Bill Spooner and Sharp Healthcare System in San Diego, California was among the 32 organizations chosen to be a Pioneer ACO.
CMS Releases New Application Template for Advance Payment ACO Model
After CMS finalized rules for its Shared Savings Program to establish Accountable Care Organizations (ACO) federal
officials also announced a new Advance Payment Model. Through the Advance Payment Model, selected physician-based and
rural ACOs participating in the Shared Savings Program will receive advance payments that will be recouped from the shared
savings they earn. The intent was to encourage ACO formation among providers who may not have all the start-up resources
needed to be successful participants in the Shared Savings Program. According to a new Advance Payment Model Application
Information webpage, the CMS Innovation Center will begin accepting applications for the Advance Payment Model on January
3, 2012 for ACOs intending to participate in the Shared Savings Program on April 1, 2012. For those ACOs looking to
participate in July 2012, Advance Payment Model applications must be submitted by March 30, 2012.
Legislation & Politics
HIPAA 5010 Timeline Comes Under Attack; ICD-10 Delay Tied to SGR Fix?
The Medical Group Management Association is calling on CMS to delay a January 1, 2012 compliance
date for HIPAA 5010 electronic transaction standards by six months. According to numbers cited in
a MGMA’s latest survey, about one-third of respondents said their organization's practice management
system has been properly upgraded and that internal testing is complete. Testing across Medicare and
Medicaid by MGMA members is at 32 percent and 18 percent, respectively. And 79 percent said they have
not yet completed testing with all commercial health plans. MGMA wants CMS to issue a "contingency plan"
that would allow health plans to continue to accept HIPAA 4010 transactions and adjudicate any 5010 claims
that lack any necessary data.
According to a CMS announcement in November, non-compliance enforcement will begin in April – although the
compliance date is remains at January 1, 2012. If there are submitters who are not yet 5010 compliant, they
are to notify Medicare FFS about their plan’s compliance status, which in some instances may result in their
ability to continue to submit 4010 transactions. This is a phased-in approach, CMS says, so that there isn’t
a logjam at the end of March.
The call for a 5010 delay comes shortly after Republicans on Capitol Hill pressed House leaders to consider,
as part of SGR negotiations, a provision that delays ICD-10. Led by Rep. Phil Gingrey (R-Ga.), he said the
new code set is “just more complicated and complex.” Rep. Gingrey is the co-chairman of the GOP Doctors
Caucus and his caucus has asked to delay the move to the new codes for at least as long as the “doc fix.”
Given the two month extension of the doc fix, look for this issue to resurface during the first part of next year.
Lawmaker Urges IOM Report to Focus on ‘Alarm Fatigue’
In a letter sent to HHS Secretary Kathleen Sebelius, Massachusetts Democrat Representative Edward Markey urged that the issue of “alarm fatigue” in healthcare be studied. Rep. Markey
believes the Institute of Medicine should look at developing “guidelines for device manufacturers and healthcare providers to protect patient safety and avoid alarm fatigue and other alarm-related safety concerns.” Markey wrote that the guidelines should cover three areas:
- How device manufacturers can minimize the number of unneeded alarms and false positives;
- What hospitals can do to make sure health care providers are trained to reduce alarm fatigue; and
- What steps FDA -- which regulates medical device manufacturers -- can take to improve adverse event reporting
CHIME News & Notes
Other News Items CHIME Is Reading:
ONC to create health IT dashboard, Government Health IT, December 21, 2011
8 key issues for population health management in 2012, Healthcare IT News, December 22, 2011
CMS: EHR incentive payments jump in November, Modern Healthcare, December 22, 2011
CHIME Policy Docs & Calendar
Interested in more information on the Shared Savings Program, Pioneer ACOs and the Advance Payment ACO model? Want more info on the SGR fix? Please contact Sharon Canner or Jeffery Smith.
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