13 Hot ACO Buzzwords All Providers Should Know
But just in case you missed a few spots, here's a quick-term glossary, culled from the nearly 116,000-word document , as well as the accompanying 8,700-word proposed statement on the ACO anti-trust enforcement policy from the Department of Justice and the Federal Trade Commission .
These proposed regulations contain multiple caveats, codicils, and exceptions. Observers are sure much of what has been proposed will be changed when the final rules are eventually published later this year.
There's plenty of time for the public to voice concerns or other comments. Deadline for those is May 31. And the date for qualified ACOs to begin is Jan. 1, 2012. Until then, it would be wise to understand the terminology.
1. The Paperwork Reduction Act of 1980 or PRA. The proposed ACO rules specifically say that the PRA, which strives to minimize the paperwork burden resulting from the collection of information by or for the Federal Government, would not apply to ACOs.
This is, in part, because rather than specifically having patients opt-out of some provisions, such as electronic information sharing, each participant will "opt-in," likely creating more forms to fill out, document and store.
2. Safety Zone. Think safe harbor. This is the promise that federal anti-trust agencies, "absent extraordinary circumstances" will not challenge the eligibility of an entity that meets other ACO criteria if its provider participants fall into this safety zone. To do so, they must have a combined share of 30% or less of each common service in an ACO participant's primary service area (PSA).
The zone is extended for ACO participants who have between 31 to 50% share of a common service area, "if it avoids specified conduct." A greater than 50% share, however, constitutes "a valuable indication of an ACO's potential for competitive harm." There are exceptions for providers in Rural Service Areas (RSA).
- Primary Care Docs Average More Hospital Revenue Than Specialists
- 69% of Employers Plan to Offer Healthcare Coverage After 2014
- How Chargemaster Data May Affect Hospital Revenue
- House Lawmakers Grill CMS Over Health Exchange Navigators
- ED Physicians Key to Half of Hospital Admissions
- Insurer's App Aims to Lower Healthcare Costs, Securely
- Don't Let Nurses Sink Your Bottom Line
- Q&A: Catholic Health Initiatives' New Senior VP for Capital Finance
- Building a Better Healthcare Board
- Hospital Pricing Irks Nurses; More Jobs, Less Pay