CMS

CMS announces new ACO model focused on primary care

March 19, 2024 - CMS will test a new accountable care organization (ACO) model that focuses on primary care providers starting next year. A recent announcement states that CMS will launch a five-year voluntary ACO model on January 1, 2025, as part of its flagship Medicare Shared Savings Program (MSSP). The model known as the ACO Primary Care Flex Model, or ACO PC...


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Making ACOs More Accessible for Long-Term and Post-Acute Care Providers

by Victoria Bailey

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) and the National Association of ACOs (NAACOS) have released recommendations on how to increase accountable care...

Overcoming the Barriers to Value-Based Payment in Primary Care

by Victoria Bailey

Primary care is arguably the most critical component of our healthcare system. Primary care and preventive medicine can help avert and manage chronic diseases and prevent long-term complications. However, efforts to improve primary care...

After Slowdown, ACO Participation in Shared Savings Program Grows

by Jacqueline LaPointe

More accountable care organizations (ACOs) are participating in Medicare programs this year, including a new, permanent payment option in the Shared Savings Program. CMS recently announced ACO...

Provider Groups Say Final Rule Will Relieve Prior Authorization Burdens

by Victoria Bailey

Provider groups are commending CMS for finalizing patient data-sharing policies and prior authorization requirements. The CMS Interoperability and Prior Authorization Final Rule requires Medicare...

New Medicaid Payment Model Targets Behavioral Health Integration

by Jacqueline LaPointe

CMS has announced a new Medicaid payment model that will incent care coordination across physical, behavioral, and social providers to improve the quality of care Medicare and Medicaid beneficiaries...

Primary Care Model Did Not Reduce Healthcare Spending or Improve Care

by Victoria Bailey

The CMS Comprehensive Primary Care Plus (CPC+) model was not associated with reduced healthcare expenditures or care quality improvements, a study published in JAMA found. CMS launched the five-year...

CMS Model Aims to Improve Maternal Health Outcomes, Access to Care

by Victoria Bailey

CMS has launched a new care delivery model to address maternal health outcomes and increase pregnancy and postpartum care access. The Transforming Maternal Health (TMaH) model will run for ten years...

How Nursing Homes Can Prepare for Staffing Standards, Gaps

by Victoria Bailey

After experiencing the brunt of the COVID-19 pandemic, long-term care facilities have prioritized strategies to improve staffing levels and care quality. The federal government has taken action, too, proposing minimum staffing standards...

CMS Will Issue OPPS Providers Lump-Sum Payments to Remedy 340B Losses

by Victoria Bailey

Hospital Outpatient Prospective Payment System (OPPS) providers participating in the 340B drug pricing program will receive a one-time lump-sum payment to offset losses between calendar years (CYs)...

CMS Finalizes 1.25% Cut To Medicare Physician Fee Schedule

by Jacqueline LaPointe

CMS has released the Medicare Physician Fee Schedule (PFS) final rule for calendar year (CY) 2024, finalizing a 1.25 percent overall reduction for physician services next year. The federal agency...

CMS Finalizes a $140M Increase to Medicare Home Health Payment Rates

by Victoria Bailey

After initially proposing a decrease, CMS has finalized a 0.8 percent increase in Medicare payment rates for home health agencies in 2024, boosting reimbursement by $140 million compared to 2023. The...

CMS Boosts End-Stage Renal Disease Medicare Rates by 2.1%

by Jacqueline LaPointe

CMS recently released the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) final rule for 2024, which includes a 2.1 percent Medicare rate hike for renal dialysis services furnished to...

Only 19% of Nursing Homes Currently Meet Proposed Staffing Standards

by Victoria Bailey

Less than 20 percent of nursing homes currently meet the proposed staffing standards for long-term care facilities, a KFF brief revealed. In September, CMS released a proposed rule with three main...

Healthcare Orgs Address Price Transparency, 340B Policies in OPPS

by Victoria Bailey

Hospital and specialty groups are urging CMS to amend aspects of the CY 2024 Outpatient Prospective Payment System (OPPS) proposed rule, including 340B Drug Pricing Program policies and price...

Provider Groups Oppose Proposed Payment Cuts in Physician Fee Schedule

by Victoria Bailey

Provider organizations have made it clear they are not happy with the payment cuts CMS proposed in the 2024 Medicare Physician Fee Schedule (PFS). Additionally, groups have voiced concerns about...

Top 10 Accountable Care Organizations by Medicare Shared Savings

by Editorial Staff

The Medicare Shared Savings Program (MSSP) saved CMS $1.8 billion in 2022, marking the sixth consecutive year of overall savings for the program. This also represents the second-highest yearly savings since the program started in...

CMS Proposes Minimum Staffing Standards for Nursing Homes

by Victoria Bailey

CMS has proposed minimum staffing standards for nursing homes, requiring facilities to provide residents with at least three hours of care per day. The Minimum Staffing Standards for Long-Term Care...

AHA Calls for Easier On-Ramp for Bundled Payments, Episode-Based Payments

by Sara Heath

The American Hospital Association wants it to be easier for hospitals nationwide to begin adopting episode-based payment models, such as bundled payments, the trade association wrote in a recent letter...

Medicare Shared Savings Program ACOs Saved $1.8B in 2022, CMS Reports

by Victoria Bailey

The Medicare Shared Savings Program (MSSP) saved Medicare $1.8 billion in 2022, with 63 percent of accountable care organizations (ACOs) earning payments for their performance. This is the sixth...