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D.C. Report: ACO Numbers Rise, HHS Holding ACA Implementation Forums

July 17, 2012
by Jeff Smith, Assistant Director of Advocacy at CHIME
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ACOs Now Treating over One Million Medicare Beneficiaries CMS can’t get enough of ACOs, so they announced another round this week. As of July 1, 1.2 million Medicare beneficiaries will be treated by providers participating in ACOs.  154 ACOs are now operational, including the 32 following the Pioneer ACO Model under CMS’s Center for Medicare and Medicaid Innovation (Innovation Center). Almost have of the organizations participating in ACOs serve less than 10,000 beneficiaries, which means smaller organizations have shown great interest in the coordinated care model.  “Better coordinated care is good for patients and it saves money,” Secretary Sebelius said in a CMS press release. “We applaud every one of these doctors, hospitals, health centers and others for working together to ensure millions of people with Medicare get better, more patient-centered, coordinated care.”

Over the next four years, savings from ACOs could amount to $940 million.

HHS To Hold Four Regional Forums on ACA Implementation In a letter yesterday this week to governors, Health and Human Services Secretary Kathleen Sebelius announced four regional forums to address questions and concerns from state officials and others as the department moves forward in implementing the Patient Protection and Affordable Care Act. Sebelius said HHS is “committed to providing states with as much flexibility as we can to achieve successful implementation of the many important opportunities provided by this legislation.” The forums are scheduled for July 31 in Washington, D.C.; Aug. 2 in Chicago; Aug. 10 in Denver; and Aug. 15 in Atlanta.

To register to attend one of the forums, go to

Proposed Rule Would Align PQRS, MU and Shared Savings Quality Measures Late last week, CMS issued a notice of proposed rulemaking that would set the physician fee schedule for federal Fiscal Year 2013.  In an effort to improve the alignment of physician quality improvement initiatives and decrease the participation burden on providers, CMS proposed in this rule to align physician quality measures that match incentives for Meaningful Use and the Shared Savings Program.  Additionally, CMS is offering more reporting flexibility for group practices involved in the Physician Quality Reporting System.

Over FFY 2013 and 2014, CMS proposes to include 264 individual measures from which doctors and other health care providers can choose to show they are meeting quality measures, including some that would be available for electronic health records reporting and would count under that incentive program as well.  CMS said it also plans to include 26 groupings of measures, some of which would align with those of the Medicare Shared Savings Program.

States Look to Leverage, Incentivize Federal Direct Protocols for Statewide Exchange This week was a big one for an ONC-led interoperability project known as Direct.  One state decided to abandon its short-term plans for statewide health information exchange to focus on Direct; another state announced incentives for providers to adopt Direct and ONC issued guidance for reporting lab results using Direct specifications.  On Monday of this week, news broke that the state of Tennessee will focus its efforts on promoting the use of Direct exchange protocols for peer-to-peer messaging, not on statewide exchange through the Health Information Partnership for Tennessee.  According to state officials, the shift in strategy is meant to meet the near-term demands of Meaningful Use and acknowledge the difficulty in sustaining statewide exchange when many providers are simply looking for Direct-like capabilities.  Tennessee now plans to “showcase Direct and broaden the education and awareness around Direct,” and the state is even working on a mechanism to certify or recommend accreditors of Direct functionality to Tennessee providers.

In Pennsylvania, the state’s health IT coordinator announced that the Pennsylvania eHealth Collaborative will pay health information service providers $250 for each healthcare provider they register, and through Aug. 15, the collaborative is offering a year's worth of free Direct messaging service to physicians and other healthcare providers who sign up.  “Depending on their needs, Direct can be a solution or a first step toward more robust and advanced types of health information exchange,” said Robert Torres, Pennsylvania's health information technology coordinator, in a news release about the incentive program.

Last, but not least, ONC this week released an implementation guide for reporting lab results using Direct specifications.  Developed and approved by the Direct – Laboratory Reporting Workgroup issued guidance for use by clinical laboratories and senders of healthcare information that require guaranteed notification of message delivery status.  According to a statement from ONC, CMS intends to issue specific guidance in the form of CLIA FAQs to inform accreditation agencies, clinical laboratories and providers that such implementations of Direct provide an acceptable technical solution for the transport of laboratory results to the final report destination.  For more information, see the Implementation Guide for Lab Results in Direct.