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CMS Taps 27 ACOs to Start Shared Savings Program

 |  By cclark@healthleadersmedia.com  
   April 11, 2012

Using the term "phenomenal" at least three times to describe the health industry's response, Centers for Medicare & Medicaid Services executive on Tuesday named 27 accountable care organizations to begin the Medicare Shared Savings Program April 1. Another 150 groups have submitted applications in hope of being accepted for the second group, to start July 1.

"There were some who doubted last year that the rule-making process would produce any ACOs," CMS's deputy administrator Jonathan Blum said in a media briefing Tuesday. "That is not the case. We have a very strong program, and a phenomenal response, and we are on track to fundamentally transform the fee-for service program and to make it more accountable to lower overall cost.

"And for anyone who doubted the ACO program last year, today's results, today's numbers, should all give us tremendous confidence that we have physicians that want to participate and want to transform care. That there are organizations that want to participate from all over the country, large, small, rural, urban, and high cost and low cost."

The ACO model, which was set forth under section 3022 of the Patient Protection and Affordable Care Act, is designed to incentivize teams of doctors, hospitals, physicians, and other providers to coordinate services in a way that improves quality of care by 33 measures and reduces cost per beneficiary. The goal is to avoid preventable hospitalizations and unnecessary imaging. Successful groups receive a share of the costs saved.

CMS officials said these first 27 groups will serve about 375,000 beneficiaries in 18 states.  They join another 32 groups that were approved under the Pioneer Model ACO in December, and six groups that were approved for the Physician Group Practice Transition Demonstration that began Jan. 1, 2011, for a total of 65 official ACO models to date.

Five of the 27 announced Tuesday will participate under separate rules of the Advance Payment ACO model, in which groups receive advance payments to set up the infrastructure to coordinate care for its beneficiaries. 

Both the Advance Payment ACO and the Pioneer models were designed in response to intense criticism of the ACO program one year ago after the proposed rule was released.  In the final rule, many of the parameters were modified, for example, the number of quality metrics reduced from 65 to 33.

Additionally, concerns about how these groups would work together and not violate anti-kickback, Federal Trade Commission and Internal Revenue Service rules were addressed with modifications to the proposed rule.

Blum said that more than half of the organizations among the latest list of 27 are groups led by physicians, which Blum said should allay fears of critics who thought that hospital organizations would dominate the ACO model.

In response to a question, Blum said that all the organizations selected to be official ACOs under the CMS model should have very strong relationships with post-discharge services such as long-term care facilities.

"To me, any ACO that's going to be successful needs think very proactively and needs to think very strategically about how they provide care for those patients who require post acute care services to ensure that patients stay healthy, and that they avoid unnecessary rehospitalization," he said.

Asked what might happen to the ACO model should the Affordable Care Act be struck down by the Supreme Court, Blum replied: "I'm not a lawyer or a constitutional scholar, so I'll defer that question to those who are. But we, as an agency, are confident that the law will be upheld.

"And I think today's announcement shows there's tremendous interest in the healthcare provider community to help us change the delivery of care."

Blum also pointed to "very positive signs" that there will be a large number of applications for the third ACO model start date of Jan. 1, 2013.

The administration has rejected only about three or four applications, although an undisclosed number who applied for the April 1 start date decided they needed more time to complete the application process, and are in line to begin July 1, he said.

The 27 organizations approved for the April 1 start date are:
• Accountable Care Coalition of Caldwell County, LLC, Lenoir, NC
• Accountable Care Coalition of Coastal Georgia, Ormond, FL (Serving beneficiaries in GA and SC)
• Accountable Care Coalition of Eastern North Carolina, LLC, New Bern, NC
• Accountable Care Coalition of Greater Athens Georgia, Athens, GA
• Accountable Care Coalition of Mount Kisco, LLC, Mount Kisco, NY
• Accountable Care Coalition of the Mississippi Gulf Coast, LLC, Clearwater, FL (Serving beneficiaries in the Mississippi Gulf Coast area)
• Accountable Care Coalition of the North Country, LLC, Canton, NY
• Accountable Care Coalition of Southeast Wisconsin, LLC, Milwaukee, WI
• Accountable Care Coalition of Texas, Inc., Houston, TX
• AHS ACO, LLC, Morristown, NJ (Serving beneficiaries in NJ and PA)
• AppleCare Medical ACO, LLC, Buena Park, CA
• Arizona Connected Care, LLC, Tucson, AZ
• Chinese Community Accountable Care Organization, New York, NY
• CIPA Western New York IPA, doing business as Catholic Medical Partners, Buffalo, NY
• Coastal Carolina Quality Care, Inc., New Bern, NC
• Crystal Run Healthcare ACO, LLC, Middletown, NY (Serving beneficiaries in NY and PA)
• Florida Physicians Trust, LLC, Winter Park, FL
• Hackensack Physician-Hospital Alliance ACO, LLC, Hackensack, NJ (Serving beneficiaries in NJ and NY)
• Jackson Purchase Medical Associates, PSC, Paducah, KY
• Jordan Community ACO, Plymouth, MA
• North Country ACO, Littleton, NH (Serving beneficiaries in NH and VT)
• Optimus Healthcare Partners, LLC, Summit, NJ
• Physicians of Cape Cod ACO Description of Organization, Hyannis, MA
• Premier ACO Physician Network, Lakewood, CA
• Primary Partners, LLC, Clermont, FL
• RGV ACO Health Providers, LLC, Donna, TX
• West Florida ACO, LLC, Trinity, FL

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