The new accountable care organization (ACO) benchmarking rule changes it so ACOs aren't just competing against themselves and transitions so ACOs have to be better than others in their region, Farzad Mostashari, MD, chief executive officer of Aledade, explained at the National Association of ACOs Spring 2016 Conference.
The new accountable care organization (ACO) benchmarking rule changes it so ACOs aren't just competing against themselves and transitions so ACOs have to be better than others in their region, Farzad Mostashari, MD, chief executive officer of Aledade, explained at the National Association of ACOs Spring 2016 Conference.
Transcript (slightly modified)
What are the proposed changes to the ACO benchmarking rule and what impact will they have?
So the big question for ACOs has been, “Is this a destination or is this just a path towards capitation?” and there’s no question that comes up more often than, “Do you get the full ratchet?” If you get savings, does your benchmark now come down to here [gesturing] and now you got to beat this and, okay, run faster, et cetera.
At some point you run out of room, right? So do you have to keep setting personal bests in order to stay in the game? And Medicare kind of punted on the issue for a while, and then they came out with a rule last year and they said “well, we’ll divide it 30-30-30, we’ll blunt the ratchet, we’ll make it a partial ratchet,” but it’s still a ratchet. And now the benchmark rule says no, you don’t have to always be better than yourself. Over time we’re going to transition to saying “you got to be better than your neighbors.” And that is what we thought they would do, that’s what we encouraged them to do, and we think it’s the right way to go.
It really creates the possibility of accountable care as a third permanent pillar, right? You have Medicare Advantage and managed care, you have fee-for-service, there could be a third pillar which is softer than managed care, but more cost control than ungoverned fee-for-service. And in this middle area, you can begin to migrate towards where most of the benchmark that you’re trying to beat is, what’s going on in your region around you. Are you more efficient than those around you, are you better at reducing the trend in cost than those around you? That is the single most important thing in the benchmark rule.
But I think the other meta-message of the benchmark rule is Medicare is going to keep working on this program to get it right over the long run. And that gives me great comfort. If someone whose company is predicated on not ACO or MSSP—we’re not an MSSP company—but really in a sustainable path for physician-led groups taking on total cost of care contracts.
CMS' 340B Repayment Proposal May Harm Vulnerable Hospitals, Reward Those With Higher Revenues
April 26th 2024The 340B hospitals not receiving an offsetting lump-sum payment from CMS following 2018-2022 cuts later ruled unlawful are disproportionately rural, publicly owned, and nonacademic, according to a new study.
Read More
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
Listen
Empowering Community Health Through Wellness and Faith
April 23rd 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In the third episode, Camille Clarke-Smith, EdD, MS, CHES, CPT, discusses approaching community health holistically through spiritual and community engagement.
Listen
Dr Dalia Rotstein: Physicians Must Be Aware MS Affects People of All Backgrounds
April 24th 2024Dalia Rotstein, MD, MPH, emphazises the importance of awareness that multiple sclerosis (MS) impacts patients from various backgrounds as clinicians think through ways to improve access to care and research efforts in MS.
Read More
The Federal Trade Commission's (FTC's) vote to ban most employers from issuing and enforcing noncompete clauses could have varying impacts on the health care workforce; federal regulators vastly under-enforced antitrust laws in the hospital sector during the last 2 decades, resulting in increased health costs; the FDA recently found genetic evidence of the H5N1 bird flu virus in pasteurized commercially purchased milk.
Read More