13 Hot ACO Buzzwords All Providers Should Know
7. TIN or Taxpayer Identification Number. Each ACO will have to have one of these as that number signifies who would be paid shared savings.
8. Dominant Provider Limitation. The FTC and DOJ would apply this limitation "to any ACO that includes a participant with a greater than 50 percent share in its PSA of any service that no other ACO participant provides to patients in that PSA. Under these conditions, the ACO participant (a "dominant provider") must be non-exclusive to the ACO to fall within the safety zone.
"In addition, to fall within the safety zone, an ACO with a dominant provider cannot require a commercial payer to contract exclusively with the ACO or otherwise restrict a commercial payer's ability to contract or deal with other ACOs or provider networks."
9. Mandatory Antitrust Review. An ACO that does not qualify for the rural exception is subjected to a mandatory federal scrutiny if its share exceeds 50 percent for any common service that two or more independent ACO participants provide to patients in the same PSA..."
One exception to mandatory antitrust review could be employed if the ACO can supply CMS with a letter from either the DoJ or the FTC "stating that the reviewing Agency has no present intention to challenge or recommend challenging the ACO under the antitrust laws."
10. Group Practice Reporting Option or GPRO. The GPRO is the method by which CMS proposes to calculate results for the first year of the program. The GPRO is similar to the Physician Quality Reporting System. CMS says that the GPRO tool is a mechanism that beneficiaries' lab results and other clinical information can be reported to CMS for determining shared savings.
Measures reported under the GPRO "must consist of at least 411 assigned beneficiaries per measure set/domain, and if the pool of eligible beneficiaries is less than 411 for any measure set or domain, then "the ACO will have to report on 100% of all assigned beneficiaries."
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