ACO Regulations Published

The proposed regulations governing accountable care organizations (“ACOs”) were published on March 31, 2011.

The goal of the ACO model is to reduce Medicare costs and improve care by focusing funds on prevention and quality, rather than the number of times a patient sees a doctor.  The ACO approach shifts from a model that focuses on production (i.e. standard treatments for illnesses) to a model that focuses on health risks and behaviors.  Behaviors are now the main force affecting health status, future expenses and outcomes.

The proposed regulations will reward ACOs that deliver better results for Medicare patients.  They will also require participating groups of primary care doctors to take responsibility for managing the care of at least 5,000 Medicare patients. 

The complete text of the proposed regulations can be viewed by accessing the following link:

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Senate Passes Medicare “Doc Fix”

The Senate unanimously passed a one-year “SGR doc-fix” on Wednesday, December 8, 2010, preventing a 25 percent cut to Medicare payments that would commence on January 1, 2011.  The measure would extend through 2011 the current reimbursement rates for physicians who treat Medicare patients.

The $19.3 billion bill still needs to be approved by the House before Congress recesses for the holidays. House approval is expected.

The bill would be paid for by changing a provision of the health reform act that provides tax credits for individuals who purchase coverage. The credit is scaled to a person’s income. The legislation would increase the amount individuals would be required to repay if they underestimate their earnings.

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