Rural ACOs Work to Overcome Challenges in Medicare Payment
Accountable care organizations (ACOs) participating in the Medicare program have had their share of challenges making their finances work, and nowhere is that more true than for rural ACOs. “Rural ACOs have found out that there are some big adjustments that need to be made to the risk adjuster,” including in Medicare’s new ACO Realizing […]
CMS Revamps Direct Contracting Model
In response to feedback from stakeholders, the Centers for Medicare & Medicaid Services (CMS) announced on Thursday that it will cancel one direct contracting accountable care organization (ACO) model and replace a second direct contacting model with a redesigned version focused on improving health equity for patients. Stakeholder groups shared clashing responses to the new […]
Should Medicare Pay the Same Amount Regardless of Where a Service Is Provided?
WASHINGTON — Medicare should do a better job of equalizing payment for outpatient care across all settings — physician offices, hospital outpatient departments, and ambulatory surgical centers — but there still should be some allowances for different costs between sites, according to members of the Medicare Payment Advisory Commission (MedPAC). “I think we do need […]
Doc Groups Seek to Reinstate Ban on Step Therapy in Medicare Advantage
WASHINGTON — Are Medicare Advantage (MA) plans allowed to require patients to go through “step therapy” to get a medication or treatment they need? Yes — for now — but physician groups are trying to change that. “On August 7, 2018, CMS (the Centers for Medicare & Medicaid Services) issued a memo to MA plans […]