A new federal analysis shows that 910,000 fewer HACs were reported from 2014 through 2017, which helped prevent 20,500 hospital deaths and saved $7.7 billion.
Hospital-acquired conditions dropped 13% from 2014 to 2017; from 99 per 1,000 acute care discharges to 86 per 1,000, according to newly released federal data.
That reduction translates into 910,000 fewer HACs, including adverse drug events and healthcare-associated infections, which helped prevent 20,500 hospital deaths and saved $7.7 billion over the three-year span, according to a new analysis from the Agency for Healthcare Research and Quality.
AHRQ's review quantifies trends for several HACs, including adverse drug events, catheter-associated urinary tract infections, central-line associated bloodstream infections, Clostridioides difficile infections, pressure ulcers, and surgical site infections.
The report showed marked declines in several categories, such as adverse drug events, which dropped 28%, and C. diff. infections, which fell 37% from 2014 to 2017.
"The updated estimates are a testament to the successes we've seen in continuing to reduce hospital-acquired conditions," AHRQ Director Gopal Khanna said.
It was not all good news, however. HACs involving pressure ulcers increased by 6%, and the number of surgical site infections didn't budge over the three years.
"There's no question that challenges still remain in addressing the problem of hospital-acquired conditions, such as pressure ulcers," Khanna said. "But the gains highlighted today were made thanks to the persistent work of many stakeholders' ongoing efforts to improve care for all patients.
The Centers for Medicare & Medicaid Services wants to reduce HACs by 20% between 2014 and 2019, which would result in 1.8 million fewer HACs over the five-year period, potentially saving 53,000 lives and saving $19.1 billion in hospital costs.
CMS Administrator Seema Verma said Tuesday that the work around reducing HACs is ongoing, as her agency develops new patient-centered measures that place outcomes over processes.
"While I am so proud of this accomplishment, we are working to get to a smaller set of dynamic measures that patients can use to identify high-value providers," Verma told theCMS Quality Conference.
Federal auditors examined the claims costs of payers participating in exchanges, and the factors driving exchange participation, premiums, and plan design.
Claims costs, pricing strategies, competition, state policies, and federal funding fluctuations were key factors health insurers considered when determining whether to expand or withdraw from the Affordable Care Act's Marketplace, a federal study shows.
The Government Accountability Office sought to determine the claims costs of payers participating in exchanges through the early years of the rollout, and the factors driving the payers' changes in exchange participation, premiums, and plan design.
To do so, GAO auditors reviewed previous studies on marketplace plans, payer data on claims costs, patient mix, and premiums, and interviewed nine marketplace payers and other stakeholders operating in California, Florida, Massachusetts, Minnesota, and Mississippi.
The study found that:
Claims costs for individual plans were higher than expected in the early years of the ACA. From 2014 to 2015, the growth in per member per month claims costs averaged 13% nationally. However, some payers saw cost claims swings ranging from a 67% decrease to a 26% increase that year.
These cost swings were attributed to enrollees being sicker than expected, higher costs for services, and federal policies that included special enrollment periods that payer feared would be abused.
Claims costs grew from 2014 to 2017. Payers blamed the volatility on large changes in the number and health of enrollees each year.
Specifically, the payers interviewed by GAO all had a greater than 50% increase or decrease in enrollment in at least one year between 2014 and 2017. Six payers had enrollment increases of more than 100% in at least one of these years.
Average monthly claims costs varied significantly across payers in the same state. Often claims costs varied by more than $100 per enrollee, a significant variance given that median per member per month claims costs were about $300.
Several factors were weighed when payers decided whether or not to expand or reduce participation in the marketplace plans, including:
Claims costs. Payers said claims costs drove decisions on participation, premiums, and plan design. They noted that increasing claims costs drove premium increases.
Federal funding changes. Payers blamed reduced participation and higher premiums on the phase-out of federal programs that helped issuers mitigate risk, including payments and adjustments for issuers with higher cost enrollees, and the ending of federal cost-sharing for some enrollees.
State requirements and funding. Payers noted that some state policies reduced participation and increased premiums, while other state policies minimized premium increases or variations in benefit design.
Most payers told GAO that their improved financial performance in the marketplace was due more to premium hikes than to decreases in claims costs.
The longer payers participated in the exchanges, the more claims data they were able to access, which allowed for more accurate projections on costs and premiums.
"Specifically, two selected issuers said 2017 was the first year that multiple years of claims data associated with the new market conditions were available to set premiums for the next year," GAO said.
The 'What's Covered' app for mobile devices lets Medicare enrollees, caregivers and others see whether Medicare covers a specific medical item or service.
The Centers for Medicare & Medicaid Services has launched a new "What's Covered" app that allows Original Medicare enrollees and caregivers using mobile devices to determine coverage for specific medical items or services.
"eMedicare is one of several initiatives focused on modernizing Medicare and empowering patients with information they need to get the best value from their Medicare coverage," CMS Administrator Seema Verma said in a media release.
"This new app is the next in a suite of products designed to give consumers more access and control over their Medicare information," she said.
In addition, CMS is using Blue Button 2.0 to enable enrollees to connect their claims data to applications and tools developed by private-sector companies to help them understand, use, and share their health data, Verma said.
Verma said the new techology is responding to increased demands on Medicare. The Medicare population is projected to increase almost 50% by 2030—from 54 million in 2015 to more than 80 million in 2030. In 2016, two-thirds of Medicare beneficiaries said they use the Internet daily or almost daily.
Medicare.gov gets about 15 million page views each year for coverage related content, and 1-800 MEDICARE gets more than 3 million coverage-related calls each year.
CMS launched eMedicare in 2018 to allow enrollees to more-easily access cost and quality information.
Other tools in the eMedicare suite include:
Enhanced interactive online decision support to help people better understand and evaluate coverage options and costs between Medicare and Medicare Advantage.
An online service that lets people quickly see how different coverage choices will affect their estimated out-of-pocket costs.
Price transparency tools that let consumers compare the national average costs of certain procedures between settings, so people can see what they’ll pay for procedures done in a hospital outpatient department versus an ambulatory surgical center.
A webchat option in the Medicare Plan Finder.
Easy-to-use surveys across Medicare.gov so consumers can continue to tell us what they want.
Robust job growth in healthcare reflects the vibrancy and importance of the sector, but it also poses problems with recruiting, retention and the pressures of wage growth for hospitals and other care venues.
Healthcare job growth was robust in 2018, and there's nothing to suggest that there won't be more of the same in 2019.
"The conditions that cause the job growth in 2018 will persist to 2019," says Ralph Henderson, president of Professional Services and Staffing at AMN Healthcare Services, Inc.
"You have retirements of Baby Boomers, an aging healthcare workforce, continuing shortages in your overall job growth, a strong economy and all of those things should produce similar results at 2019 for these various professions."
Travis Singleton, a vice president at physician recruiters Merritt Hawkins, agrees.
"I don't see any way it couldn't be," he says. "Just starting with supply, the most-recent projection is a shortage of up to 121,000 physicians by 2030."
In 2018, healthcare created 346,000 new jobs, up from 284,000 jobs in 2017, according to the Bureau of Labor Statistics. The 2018 figures include 219,000 jobs in ambulatory services and 107,000 hospital jobs.
While the robust job growth in healthcare reflects the vibrancy and importance of the sector, it also poses problems with recruiting, retention and the pressures of wage growth for hospitals and other clinical venues.
Singleton says the demand for jobs will be felt across the healthcare space.
"There's a lot of talk with primary care and everything that goes with primary care; the physician extenders, the team-based health, nursing and all those things," he says. "There's going to be huge need for that. But what most people don't realize is that 72,000 of that physician shortage is specialists."
"This idea of preventative care and medical homes is good, but you can't manage your way out of the fact that 10,000 Baby Boomers are turning 65 every day," Singleton says. "That demographic is 14% of the population, but it's still generating about 34% and 37% of our diagnostics and procedurals, respectively."
The growing numbers of employed physicians and other clinicians presents good and bad news for health systems.
"The good thing about that is it allows health systems to be very nimble and aggressive to recruit providers and they have been," Singleton says. "You don’t see a lot of independent contractors. You don’t see a lot of partnerships. They're almost all on an employed basis."
"The bad news is it's very tough on retention," he says. "If you think five, six years ago, the physicians had their team and they own the practice, they own the equipment, they have the patient panels, they dealt with your family. In other words, you couldn't just have a bad day and walk away."
"Now we're starting to see—especially on the facility level—that retention is really starting to struggle. You're starting to see people change flags. They don't even relocate. They just go to a different system because they don't like the way they're treated."
"It was already ultra-competitive, and we already had a supply problem, and now it's about recruiting, retention, and engagement. If you're not good at all three of them, I don't know how you survive in the next two, three years," Singleton says.
Henderson says that health systems that he works with are budgeting for wage growth of up to 2.5% in 2019, although that growth could be higher in more-competitive regions on the East and West Coasts and in major hubs.
"We've seen big investments in the last three years on recruiting to help capture more of this shrinking supply, and we're seeing them put in place incentives for employees to stay longer and not retire," he says.
What should health systems do to improve recruiting and retention?
"I wish there was one magic bullet. We would just tell everyone exactly what that is," Henderson says. "Most are spending time defining their employee value proposition, making sure people understand their culture better, becoming more flexible in who they would consider for positions sometimes the standards get ratcheted up, and that can be detrimental to hitting your hiring goals."
"Others are investing in new options to make their existing labor more effective, like scheduling tools, technologies that make the job easier for people, and they start to market those things to prospective candidates," he says. "So, it's not just the job and what it pays, it's what our environment is, how we support you on the job. Those healthcare systems have a leg up in competing for new talent."
Singleton urges health systems to "figure out where you're vulnerable."
"We see so many of these beautiful plans that are drawn up in these strategic boardroom sessions about what they want their health system to be," he says. "That's great, but who's going to do it? Who's actually going to carry it out? We find a lot of health systems where, unbelievably, that's still a flaw in the strategy."
Dartmouth-Hitchcock Health is anchored by the 396-bed Dartmouth-Hitchcock Medical Center in Lebanon, the largest hospital in the state. GraniteOne Health includes flagship Catholic Medical Center, a 330-bed hospital in Manchester.
Two of New Hampshire's largest hospitals have signed a nonbinding letter of intent to combine their two organizations.
In ajoint media release, Dartmouth-Hitchcock Health and GraniteOne Health said the merger "will build on years of successful community engagement and clinical collaboration in order to meet the growing demand for seamlessly integrated primary, specialty, ambulatory and inpatient care, offering patients a high-quality, lower-cost, New Hampshire-based alternative choice to out-of-state providers."
The health systems described the letter of intent is first step in what they expect will be a lengthy process of at least 18 months that will include due diligence, public input, and clearance from state and federal regulators.
"As the healthcare landscape continues to evolve, it is important for healthcare systems to evaluate how we can best serve our patients and communities, and prepare for the future so we can continue to provide the high level of care that people expect," said Dartmouth-Hitchcock CEO Joanne M. Conroy.
"By combining these two top healthcare organizations, we would create a patient-focused, unique and unparalleled option for New Hampshire that is responsive to community needs and patients' desire for cost-effective, high-quality care," she said.
Dartmouth-Hitchcock Health serves New Hampshire and eastern Vermont, anchored by the 396-bed Dartmouth-Hitchcock Medical Center in Lebanon, the largest hospital in the state, and New Hampshire's only academic medical center. The health system includes the Norris Cotton Cancer Center, and the Children's Hospital at Dartmouth-Hitchcock, the state's only children’s hospital.
GraniteOne Health includes flagship Catholic Medical Center, a 330-bed hospital in Manchester, along with the New England Heart & Vascular Institute, Huggins Hospital in Wolfeboro, and Monadnock Community Hospital in Peterborough.
The merger would expand Dartmouth-Hitchcock's footprint in the Manchester service area.
Catholic Medical Center will continue to adhere to its Catholic care model while Dartmouth-Hitchcock will continue to serve its patients in all its existing healthcare venues. All care venues in the combined system will keep their current names, identities, and local leadership.
"I am impressed with the deliberate discussions that have taken place thus far and I believe that this combined system would strengthen Catholic Medical Center's ability to care for the suffering and sick in our community, while at the same time maintaining the integrity of its Catholic identity," said the Most Reverend Peter Libasci, Bishop of Manchester.
Conroy said Dartmouth-Hitchcock respects the historical role that Catholic Medical Center has played in the Manchester area. At the same time, she told Vermont Digger that Dartmouth-Hitchcock would continue to provide contraception, fertility treatment and sterilization services.
"Healthcare is a deeply personal experience and it is important to assure all our patients that they will continue to receive the healthcare services they want and need, at the place and time they want them," she said.
News of the proposed merger comes less than one year after the New Hampshire Attorney General's office gave the go-ahead to the merger of Elliot Hospital in Manchester and Southern New Hampshire Health in Nashua.
The approval was granted, even though state regulators said the information about the merger provided by the two hospitals "lacks the specificity needed to confirm that it is in the best interest of the communities the organizations serve."
Among the concerns raised in the report is that the merger could reduce competition among health providers in Southern New Hampshire, possibly leading to increased costs for consumers. But state reviewers determined that the merger can proceed as proposed by the hospitals.
Dartmouth-Hitchcock had attempted unsuccessfully to affiliate with Elliot before it merged with Southern New Hampshire Health.
Payers admit they may have 'overreacted' the political uncertainty created in Washington in 2018 during the fight over the future of the Affordable Care Act.
The Affordable Care Act's Marketplaces in 2019 had more insurers participating, saw modest premium hikes, and in some cases premium decreases, when compared with 2018, a new analysis shows.
Researchers at the Urban Institute interviewed marketplace insurers in 10 states (California, Florida, Georgia, Indiana, Maryland, Minnesota, Ohio, Virginia, Washington, and West Virginia) and found that they were more willing to enter new markets in 2019.
The findings are a sharp contrast to 2018, when a number of insurers fled the marketplaces as the Trump Administration and a Republican-controlled Congress attempted to abolish or hobble the ACA.
"The ACA marketplaces have rebounded from a period of political and policy uncertainty, which caused premiums to spike last year and issuers to think twice about participating,” said Anne F. Weiss, managing director at the Robert Wood Johnson Foundation, which funded the study.
"Political stability, along with support for people with modest incomes, are key ingredients for lower premiums and more marketplace choices," Weiss said.
John Holahan, a fellow at the Urban Institute, says executives he spoke with in many of the Marketplace plans admitted that they "overreacted" to the political uncertainty in 2018.
"They were very fearful of what was going on with the Trump Administration and the threat to the individual mandate and less money for outreach and enrollment, and the shorter enrollment period, and all those things that it would cause complete chaos," Holahan said.
"But, it kind of didn't, and that allowed them to go into 2019 feeling more comfortable that their pricing was adequate, if not more than adequate," he said. "We're seeing smaller premium increases in 2019, because they're where they need to be, and insurers did enter new markets in 2019 and they're actively looking to in 2020 to do more or less do the same thing."
The payers also figured out how to make the Marketplaces work for them. The study noted shifts between 2018 and 2019 that show more plans offering narrow provider networks to contain costs and limit networks to high-performing providers.
"What's left unsaid," Holahan said, is the lack of participation in the Marketplace plans from the "big players."
"You don't see United, Aetna, Humana, or Anthem coming back into a lot of these markets. Those big guys are still staying out so the market's not that great," he said, adding that BlueCross plans have been active, but use HMOs with tighter networks than their commercial plans.
What would it take to lure big payers back into the Marketplaces?
"We'd have to agree that the ACA is here to stay, and it's stable, and there's more money coming in to make the subsidies more generous so you get bigger enrollment," Holahan said. "For a lot of these guys there aren't enough covered lives to make it worth coming in, compared to Medicare Advantage or the commercial markets they participate in. It's still small."
A new report by federal auditors offers observations about the merits of voluntary and/or mandatory participation in Medicare alternative payment models.
The Government Accountability Office this week issued a report that examines the pros and cons of mandatory versus voluntary participation in Medicare alternative payment models.
The auditors examined six Medicare episode-based payment models that were in place in early 2018, only one of which was mandatory, and asked participating providers what they liked and disliked about the models.
"In general, stakeholders reported that voluntary models largely benefit providers," GAO said.
"For example, these models tend to have more generous terms and providers can choose to participate in only those models where they are likely to be successful. On the other hand, mandatory models are more likely to give CMS generalizable evaluation results," GAO said.
The auditors looked at six episode-based payment models. Here's what they found:
Voluntary
Participants often have more favorable incentives and degrees of risk required than in mandatory models because CMS wants to make the model attractive.
Participants can self-select models and episodes where they have identified care redesign opportunities and feel they can earn performance bonuses.
CMS is better able to test novel concepts in care redesign with early adopters. This allows CMS to assess the feasibility of a model before additional testing.
Mandatory
CMS is better able to evaluate performance that is more representative of different types of providers, with results that are more generalizable.
CMS can test models with greater financial risks and penalties because providers are required to participate.
CMS can encourage transition from traditional Medicare to value-based care models among providers that may be reluctant to make the change on their own.
Regardless of voluntary or mandatory status, GAO found that providers in the episode-based payment models were bigger, had higher volumes, and were more often in urban areas, when compared to traditional Medicare providers.
The participating providers told GAO they entered the voluntary models because they thought they could meet the metrics and make money.
Health and Human Services Secretary Alex Azar is a firm believer in mandatory payment models. During his confirmation hearings last January Azar told the Senate Finance Committeethat "we need to be able to test hypotheses."
"I want to be a collaborative in doing this. I want to be transparent and follow appropriate procedures. But if to test a hypothesis around changing our healthcare system it needs to be mandatory as opposed to voluntary to get adequate data, then so be it," Azar told the committee.
Azar reiterated his support for mandatory models in a November speech at the Patient-Centered Primary Care Collaborative Conference.
"Bundled Payments for Care Improvement is a voluntary model, where potential participants can select whether they want to join. But we're not going to stick to voluntary models," Azar told the conference.
"BPCI Real experimentation with episodic bundles requires a willingness to try mandatory models. We know they are the most effective way to know whether these bundles can successfully save money and improve quality," he said.
Azar in November suggested that radiation oncologists would soon be placed in a mandatory alternative payment model, which raised concerns from radiologists.
"We have some reservations about moving forward in a mandatory fashion and really need to learn more about what the secretary has in mind," said Dave Adler, vice president for advocacy at the American Society for Radiation Oncology.
"Our biggest concern would be going 'full mandatory,' where every radiation oncologist is required to participate in this model on Day One. That may be too much and too fast. But it'd be premature to say we object to mandatory model without having those details," Adler said.
The Medicare risk models are designed with the hope of slowing surging costs in the program.
A 2017 report by GAO found that traditional Medicare expenditures in 2017 totaled $394 billion, and that number is expected to grow to $730 billion by 2027, an 85% increase.
The increase will be driven by a number of factors, including an increase in the number of services provided per beneficiary.
Hospital stakeholders call for accelerating 'truly interoperable system' that advances best practices while ensuring accuracy, standardization, accessibility and security.
The nation's seven largest national hospital associations have released a report urging all stakeholders to accelerate interoperability.
"We see interoperability in action all around us. Mobile phones can call each other regardless of make, model, or operating system," said American Hospital Association President and CEO Rick Pollack.
"The hospital field has made good headway, but it's time to complete the job. We are united in calling for a truly interoperable system that allows all providers and patients to benefit from shared health records and data, leading to fully informed care decisions," Pollack said.
The hospital associations note that 93% of hospitals are now making records available to patients online, and 88% share records with ambulatory care providers outside of their systems.
Security and Privacy: Shared data must be accurate, secure, and used in accordance with best practices.
Efficient, Usable Solutions: Data must be available when and where it's needed, and in a usable format.
Cost Effective, Enhanced Infrastructure: Data sharing networks must apply common standards and a common set of "rules of the road" for the exchanges.
Standards that Work: Build standards that drive consistency and minimize proprietary solutions and gatekeeping
Connecting Beyond Electronic Health Records: Interoperability must also support population health, address social determinants of health, and facilitate remote monitoring of patient-generated data.
Shared Best Practices: All stakeholders should share best practices and support what works.
"For the best care today, it's the data stupid, Federation of American Hospitals President and CEO Chip Kahn said.
"Quality care depends on having the right information at the right time so our patient's records need to be available in the hospital or wherever our patients receive care," Kahn said. "Hospitals are joining together to support improving interoperability because it is the key to assuring the best for our patients."
The contributors to this report include: America's Essential Hospitals, American Hospital Association, Association of American Medical Colleges, Catholic Health Association of the United States, Children's Hospital Association, Federation of American Hospitals and the National Association for Behavioral Healthcare.
The acquisition of the 425-bed Palos Hospital and its affiliate services would expand Loyola's presence in the southern and southwestern suburbs of Chicago.
Palos Health and Loyola Medicine have signed a non-binding letter of intent that could end with a merger, the two Chicagoland health systems announced jointly on Monday.
The non-profit health systems said they hope to build on a strategic partnership that began in 2015, and they're entering the due diligence process with the goal of Palos Health and its affiliates joining Maywood-based Loyola, which is also a member of Trinity Health.
"We have built a strong relationship with Palos over the years," said Shawn P. Vincent, president and CEO of Loyola Medicine and president of Trinity Health's Illinois region.
"Many physicians at Palos Health trained at Loyola University Medical Center and we have been providing tertiary care to Palos patients in the south and southwest suburbs for decades. A strong partnership with the exceptional clinicians at Palos will provide greater value to the members of our communities," he said.
Palos Heights-based Palos Health is located in Chicago's south and southwestern suburbs and includes the 425-bed Palos Hospital, an affiliated medical group, an imaging and diagnostic center, home care and hospice services, and an integrated physician network.
"We are operating in an incredibly dynamic healthcare landscape," said Palos Health President and CEO Terrence Moisan, MD. "Over the past few years, we've steadily evolved our institution to not only respond to these changes, but to capitalize and drive forward in a position of strength.""By fully integrating with Loyola Medicine, we will enhance our clinical strength, increase our flexibility and provide our community with more comprehensive care across an expanded region," Moisan said.
Last year, Palos opened an 83,000-square-foot expansion of the Palos Health South Campus in Orland Park, which features 47 specialty and primary care exam rooms, staffed by Loyola physicians. Palos and Loyola jointly own an outpatient surgery center and a radiation oncology center.
Loyola Medicine includes the 547-bed Loyola University Medical Center in Maywood, the 247-bed Gottlieb Memorial Hospital in Melrose Park, and MacNeal Hospital, a 374-bed teaching hospital in Berwyn that was acquired from Tenet Healthcare Corp. in 2018.
The health system also includes a large ambulatory network with locations throughout Cook, Will and DuPage counties.
The due diligence process is expected to take several months. The terms of the letter of intent are not being disclosed.
The merger talks come as analysts foresee M&A activity among nonprofit health systems to continue through 2019. These consolidations are driven by tight finances challenging nonprofit health systems, and by the entrance into the provider space by nontraditional players, such as the newly consolidated CVS and Aetna.
Moody's Investors Service said this month that it expects nonprofit health systems to engage in partnerships with other hospitals, and to align with companies specializing in data analytics or ridesharing services to continue the transition from inpatient care to outpatient care.
Stakeholders say the existing February 19 application deadline for the Medicare Shared Savings Program 'will be challenging, if not impossible' to meet.
Key stakeholders including the American Medical Association and the American Hospital Association are urging federal policymakers to extend by at least one month the application deadline for the new Pathways to Success program.
CMS released the 267-page final rule for Pathways to Success under the Medicare Shared Savings Program in late December, and announced earlier this month that applications to participate in the program would be due February 19.
The provider associations say that's not enough time.
"Due to the complexity of CMS's new final rule for the program published in the Federal Register on December 31, 2018, many existing ACOs and those in the process of formation are still actively working to understand how they may successfully participate in the program," they wrote in a joint letter Friday to Centers for Medicare & Medicaid Administrator Seema Verma.
The stakeholders asked Verma to push back the deadline until at least March 29. The MSSP begins on July 1.
"Additional time is needed to ensure ACOs may evaluate their options and complete the administrative and legal requirements of the application. Without additional time, participation in this voluntary program will suffer," the letter said.
The organizations that signed the letter include the AHA, AMA, American College of Surgeons, America's Essential Hospitals, the American Academy of Family Physicians, the Federation of American Hospitals, the Medical Group Management Association, the Association of American Medical Colleges, and the National Association of ACOs.
NAACOS had already pressed CMS to extend the deadline in a January 10 letter to Verma.
The other stakeholders climbed on board after noting that successful ACOs "are not typically a single entity but rather a network of different providers affiliated under the legal umbrella of the ACO including physician groups, hospitals, and skilled nursing facilities."
"To be successful, ACOs need time to obtain buy-in from ACO entity participants, boards and leadership regarding new or continued participation," the letter said. "Some ACOs can include nearly 200 unique sets of providers and must secure sign-on from multiple boards and governing bodies before finalizing applications."
NAACOS in its commentsto the August proposed rule recommended CMS allow ACOs with agreements expiring in 2018 to extend through December 31, 2019. NAACOS last June urged CMS to provide information regarding the expected timeline for 2019 applications so that organizations may begin to prepare for a condensed application period.
The February 19 deadline applies to new ACOs, ACOs whose agreements expired at the end of 2018, and ACOs who want to end their current agreements and start under the new Pathways structure.
ACOs with three-year agreements that expire at the end of 2019 or 2020 are allowed to finish those contracts before starting in the new structure.
The condensed deadline comes as ACOs also contend with a March 1 deadline to apply for CMS's Bundled Payments for Care Improvement Advanced Model.
