The NCMS Accountable Care Task Force met this week in Raleigh. The group, chaired by Steven Wegner, MD, discussed the progress of several North Carolina entities that are implementing programs to improve quality and bring greater accountability to the practice of medicine.  Many of these groups are in the process of applying to become Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program while others are implementing new models of care.

Click below to review each of the presentations given:

• Steven Wegner, MD, JD: Advancing Accountable Care
• Grace Terrell, MD: Case Study: Cornerstone Health Care
• John Rezen: Pinehurst Surgical
• Jeff James: Wilmington Health/Community Partners Health Plans

The Task Force is working on educational modules to help medical practices work toward new models of care delivery. More information regarding NCMS efforts to move toward accountable care can be found by visiting our Accountable Care webpage.

The American Medical Association (AMA) and The Centers for Medicare & Medicaid Services (CMS) will be holding a provider call on Monday, January 23, 2012, 7:00 pm, to discuss the Accountable Care Organization (ACO) Advanced Payment program. This is a great opportunity for physicians interested in learning more about and applying for the ACO Advanced Payment program.

CMS officials will be able to answer participants’ questions about the program and how physician-led Medicare ACOs can qualify for up to $250,000 in up-front payments and more than $1 million in monthly payments through this new initiative.

The provider call is free to AMA members and non-members. The call is hosted in conjunction with the Medical Group Management Association (MGMA). Click here to register.

NCMS members can also refer to the Accountable Care section of our website to learn more about this initiative.

Section 3022 of the Patient Protection and Affordable Care Act (PPACA) mandates the creation of the Medicare Shared Savings Program. The Shared Savings Program establishes the goals of providing better care, improving population health and lower growth in expenditures.

Final Rules for the program were released on October 20, 2011, and published in the Federal Register on November 2, 2011. The application and instructions for the Medicare Shared Savings Program can be found on the CMS website, https://www.cms.gov/sharedsavingsprogram/37_Application.asp#TopOfPage.

Application Timeline:

Notice of Intent

The first step in the application process is to submit your Notice of Intent (NOI) to Apply to the Shared Savings Program. After completing this form, CMS will assign you an ACO identification number. The NOI must be completed by 5 pm EST on January 6, 2012, for the April 1, 2012 program start date and by February 17, 2012, for the July 1, 2012 program start date.

Obtain a CMS User ID

Following the submission of your NOI form you will receive a confirmation e-mail from CMS containing your ACO ID and instructions on how to complete the CMS User ID application.  Without these two ID numbers you will not be able to fully access the modules of the 2012 program application.

Complete the CMS User ID form and return it to CMS via tracked mail no later than January 12, 2012, for the April 1, 2012 program start date and no later than February 23, 2012, for the July 1, 2012 program start date.

Apply for the Shared Savings Program

Once both ID numbers have been received complete the application packet found on the CMS website, https://www.cms.gov/sharedsavingsprogram/37_Application.asp. The application is due by January 20, 2012, for the April 1, 2012 program start date and by March 30, 2012, for the July 1, 2012 program start date.

Applications will be approved or denied no later than March 16, 2012, for the April 1, 2012 program start date and by May 31, 2012, for the July 1, 2012 program start date.

If your application is denied you may request a CMS reconsideration review. This request must be made within 15 days of the date of your denial letter.

Any questions regarding the Medicare Shared Savings Program Application can be directed to SSPACO_Applications@cms.hhs.gov.

The Centers for Medicare and Medicaid Services (CMS) will host a National Medicare Provider Call, Tuesday, November 15, 2011, 1:30 pm – 3:00 pm, to discuss the application process for the Medicare Shared Savings Program and the Advance Payment Model. This call-in forum is designed to help providers participate in the Medicare Accountable Care Organizations to improve quality of care for Medicare patients. A question and answer session will follow the presentation.

In order to participate and receive call-in information, you must register for the call. Registration will close at 12:00 pm on Tuesday, November 15, 2011, or when available space has been filled.

For more details, including instructions on registering for the National Provider Call, please visit: http://www.eventsvc.com/blhtechnologies.

Click here for more information about the November 15 Open Door Forum, as well as details on the November 7, 2011 Physicians, Nurses and Allied Health Professionals Open Door Forum to discuss the pending 2012 Physician Payment Rule.

Updates and other information about Accountable Care can be found on the NCMS Toward Accountable Care webpage.

The Centers for Medicare and Medicaid Services (CMS) Innovation Center is reminding physicians and practices that letters of intent to participate in the Comprehensive Primary Care Initiative are due next Tuesday, November 15, 2011. The Center announced the initiative on September 28, 2011, stating it was designed to help primary care practices deliver higher quality, better coordinated, and more patient-centered care.

Click here for a Fact Sheet on the Comprehensive Primary Care Initiative.

The Letter of Intent is non-binding and confidential, and should include:

Payer Name

Corporate Address

Corporate City

Corporate State

Point of Contact name, title and address (if different)

Point of Contact email address

Information about the areas that have provider network(s) and are considering participation in the initiative, fill out the CMS Innovation Center’s geographic service area worksheet template at: http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/cpci/. (This link also provides more information and instructions.)

Questions may be sent to: mailtoCPCi@cms.hhs.gov.

The Centers for Medicare and Medicaid Services (CMS) reminds physicians that applications for the Innovation Advisors Program are due next Tuesday, November 15, 2011. The program seeks to help professionals enhance skills that will drive improvements to patient care and reduce costs.

More information can be found at: http://innovations.cms.gov/innovation-advisors-program.

Applications for the Innovation Advisors Program can be accessed at: http://orise.orau.gov/IAP.

Questions may be emailed to IAP@orau.org.

For more information about the CMS Innovation Center, please visit: http://innovations.cms.gov/.

In its highly anticipated final blueprint for the Medicare Accountable Care Organization (ACO) program, the Centers for Medicare and Medicaid Services (CMS) adopted many of the NCMS, AMA and other physician organizations’ suggestions for encouraging physician-led Medicare ACOs. On Monday, November 21, 2011, at 7:00pm Eastern Time, AMA President-Elect Jeremy Lazarous, MD, and national expert Harold Miller will lead a 60-minute webinar that will outline significant improvements and opportunities for physicians in the final ACO rule.

The webinar will highlight changes to the ACO Rule, which came after the highly successful NCMS/AMA Pathways to Success ACO Seminar that was held in July in Research Triangle Park. Included will be discussion about the application process and Q&A about ACOs and other payment innovations.

Click here to register for the webinar, which is free to AMA members and nonmember physicians and their staff.

See related article:

What Do the Final Rules Mean for Providers?, Bulletin, 10-28-11

In last week’s edition of the Bulletin, NCMS announced the CMS release of final rules regarding Accountable Care Organizations. This week we bring you a broad overview of the new rules, authored by Kim Licata of Poyner Spruill LLP.  The summary details CMS discussion of the rules during a recent Open Door Forum and lets physicians know what shared savings may mean for them. Read the summary here.

CMS will also be holding an in-person meeting to help physicians understand the goals of Accountable Care Organization (ACO) models. CMS will provide an overview of the Medicare Shared Savings Program Final Rule and new tools that will help physicians and other health care providers improve quality of care. The meeting will be held on Monday, November 21, 2011, 1:00-2:00 pm at the Centers for Disease Control & Prevention, Tom Harkin Global Communications Center, Atlanta, Georgia.

There will be a listen-only conference line available to those who cannot attend the meeting. Call (877) 267-1577 and enter meeting ID 4494 to listen to the meeting.

Additional helpful links regarding Accountable Care:

• Advanced Payment Model
• Office of Inspector General (OIG) Waivers
• FTC/DOJ Statement

Questions for the November 21 meeting should be submitted by November 15, to Teresa Wilson, Health Insurance Specialist, at tersea.wilson@cms.hhs.gov. If time permits, there will also be a Q&A session at the end of the meeting.

The federal government continued its push toward accountable care as it launched two initiatives derived from the Affordable Care Act (ACA) on Thursday–the Medicare Shared Savings Final Rule and the Advance Payment Model. The Centers for Medicare and Medicaid Services (CMS) said the Final Rule incorporates many changes recommended by hospitals and physician groups that were critical of the draft Rule, when it was first published in March. More than 1,200 comments were submitted, according to the CMS. One notable change was a reduction in quality measures that would be monitored by CMS, from 65 in the original proposal to 33 in the Final Rule.

The Shared Savings Program Final Rule can be seen at: http://www.ofr.gov/OFRUpload/OFRData/2011-27461_PI.pdf.

In June, the NCMS Accountable Care Task Force addressed the proposed Rule in a letter to CMS Administrator Donald Berwick, MD. NCMS President John R. Mangum, MD, stated in the letter, “While the NCMS strongly supports the goals of the Shared Savings Program to improve health and quality and to control costs, we are convinced that the proposed ACO rules are seriously flawed and that, as currently structured, the Shared Savings Program is likely to fail.”

The letter followed an intensive eight-week review of the Rule by the NCMS Task Force, chaired by Steve Wegner, MD, JD. Read the letter here.   

CMS says the Advance Payment Model will provide additional support to physician-owned and rural providers participating in the Medicare Shared Savings Program. Included are start-up resources to build needed infrastructure, such as new staff or information technology systems. Details about the Model are available at http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/advance-payment.

The NCMS will be reviewing the Medicare Shared Savings Final Rule and Advance Payment Model and will provide additional updates in future Bulletins and in the Toward Accountable Care section of the NCMS website.

North Carolina physicians and group managers who are interested in becoming accountable care organizations (ACOs) may want to consider attending the Final 2011 ACO Accelerated Development Learning Session, November 17-18, at the Centers for Medicare and Medicaid Services in Baltimore. The session is designed to teach the steps needed to improve health care delivery and how to develop an action plan for moving toward providing better coordinated care. The content at each session is repetitive and is not part of an ongoing series.

Register for the ACO Learning Session at https://acoregister.rti.org/.

Learn more about ACOs by visiting the NCMS Toward Accountable Care web resource page: http://www.ncmedsoc.org/pages/advocacy_govt_affairs/accountable_care.html.

The NCMS Foundation has been awarded a grant by the Pfizer Foundation to fund The North Carolina Patient Centered Medical Home Center (PCMHC) Technical Assistance Project, which will provide a wide range of web-based resource materials customized to meet the specific needs of North Carolina physicians. The Project resources are tailored to assist physicians in embracing patient centered medical home (PCMH) principles and policies in their practices. 

The PCMHC project is focused on helping the physician community respond effectively and appropriately to PCMH and accountable care organizations (ACO) provisions in the recently-passed federal health care reform law.

The proposed NCMS Foundations web-based educational and technical assistance effort will include:

• Resources for analyzing the business case for PCMH interventions  
• A “toolbox” of programs and actions to reduce hospitalizations or other high utilization services
• Providing training in process improvement techniques through NCMS Foundation’s PractEssentials program.
• Helping physician practices understand the value of developing patient registry and other systems (especially electronic health records) that track populations of patients

This project will serve as a catalyst to help the North Carolina medical community continue to improve the patient care delivery system and serve as an important state model for patients, providers and public and private policy makers.

For more information, please contact Terri Gonzalez, Practice Technical Assistance Coordinator, North Carolina Medical Society Foundation at 919-833-3836 or tgonzalez@ncmedsoc.org.

The U.S. Department of Health and Human Services (HHS) announced Tuesday a new program called the Medicare Bundled Payments for Care Improvement Initiative. Based on provisions in the Affordable Care Act, the initiative builds on earlier programs like the Acute Care Episode (ACE) and gainsharing demonstration programs. Instead of paying for services separately, HHS says the bundled initiative will align payments for services delivered across an episode of care, such as a heart bypass or hip replacement.

Current Medicare rules prohibit hospitals from sharing savings with physicians who help them lower costs by, for example, negotiating discounts on implantable devices. The bundling initiative waives these prohibitions so that hospitals, physicians and post-acute care providers can coordinate and share in savings from improving care and lower costs.

The NCMS believes that various payment models should be available to physicians on a voluntary basis.

If you know of physician organizations that plan to apply for one or more of the bundled payment models, please contact Melanie Phelps at mphelps@ncmedsoc.org or 919-833-3836.

There are four different models in the bundling initiative. More information can be found by going to the following links, which include a news release, fact sheets and a Request for Applications.

http://www.hhs.gov/news/press/2011pres/08/20110823a.html

http://www.healthcare.gov/news/factsheets/bundling08232011a.html

http://www.innovations.cms.gov/documents/payment-care/Request_for_Applications.pdf

As explained in the documents, September 11, 2011 is the deadline for letters of intent for Model 1, and November 4, 2011 is the deadline for Models 2, 3 and 4.

Click here for additional resources on the NCMS Toward Accountable Care webpage.

While enactment of SB 33 – Medical Liability Reforms was a major achievement for the NCMS Legislative Affairs team this legislative session, dozens of other bills of interest to physicians will also be included in the soon-to-be released 2011 Legislative Summary. Watch for more details in the Bulletin and at http://www.ncmedsoc.org/.

In last week’s Bulletin, we reported on legislation that falls under the category of Regulation of Medicine. That section includes 12 bills that will be summarized in the 2011 Legislative Summary, including the widely reported HB 854 – A Woman’s Right to Know Act. Like SB 33, HB 854 became law after the General Assembly overrode a gubernatorial veto.

Another major category of legislation falls under the Implement Federal Programs umbrella. Several of these bills deal with issues arising from the Patient Protection and Affordable Care Act (ACA):

HB 2 – Protect Health Care Freedom

SB 496 – PPACA/Required Fraud and Abuse Provisions

HB – 115 North Carolina Health Benefit Exchange Act

SB 375 – Facilitate Statewide Health Information Exchange

SB 607 – Conform Medical Records Law

In addition to the 2011 Legislative Summary, the NCMS offers more information and updates on a variety of provisions contained in the federal health care reform law, including Accountable Care Organizations (ACOs), the NC Health Benefit Exchange, and the NC Health Information Exchange. Physicians are urged to check the NCMS website to learn more about these programs and how they will be affecting your practices.

Related story:

Legislative Summary Highlights Major Accomplishments in 2011, Bulletin, August 5, 2011

A new resource from the AMA is available for physicians to better understand the movement toward accountable care organizations (ACOs) and other payment models resulting from the new federal health care reform law. Attorneys Steve Shaber, Kim Licata and Wilson Hayman from the Poyner Spruill law firm in Raleigh contributed to this resource. Shaber and Licata serve on the NCMS Accountable Care Task Force.

Click here to access a pdf-version of ACOs, CO-OPs and other Options: A “How-To” Manual for Physicians Navigating a Post-Health Reform World.   

Additional resources and information are available on the NCMS Toward Accountable Care webpage.  

On July 16, sixty physicians and practice managers from across the state gathered at the Hilton Raleigh-Durham Airport for a daylong seminar on ACOs hosted jointly by the NCMS and the AMA 2011 Pathways to Success Program. Moderated by AMA President-Elect Jeremy A. Lazarus, MD, the presentation focused on what physicians need to know about ACOs and the coming changes in payment practices. These presentations are available on the Toward Accountable Care Website and include:

• Pathways for Physician Success in Accountable Care Organizations and Healthcare Payment Reform – Harold D. Miller, Executive Director, Center for Healthcare Quality and Payment Reform (PDF-59 pages)
• Cornerstone Health Care: Running with the Bulls and Eating Elephants – Grace E. Terrell, MD, Practicing Physician at Cornerstone Health Care (PDF-41 pages)
• Health Care Reform or Health Care Dystocia? Where Do ACOs Fit in? – Craigan L. Gray, MD, MBA, JD, Director, Division of Medical Assistance, State of North Carolina (PDF-15 pages)
• Community Care of NC: Advancing Accountable Care in NC – Steven E. Wegner, MD, JD, Chair, North Carolina Community Care Network (PDF-20 pages).
• Specialist Strategies for Improving Quality and Lowering Costs – Alan M. Speir, MD, Chairman, Virginia Cardiac Surgery Quality Initiative (PDF-28 pages)
• Federal Policy on the Next Generation of Physician Payment – Jeremy A. Lazarus, MD, President-Elect, American Medical Association (PDF-12 pages)

Other Helpful Practice Resources Available from NCMS

In addition to the AMA resource on ACOs and other payment models, Wilson Hayman and Steve Shaber worked on the NCMS physician hospital contracting white paper and presentations, which are available on our Physician-Hospitals webpage at http://www.ncmedsoc.org/members/members/physician_hospital/HospitalPhysicianEmploymentAgreements.DOC.

Steve Shaber offers review of medical staff by-laws, employment contracting and other services. Click here for the Resources for Employed Physicians flyer.

To see the NCMS Model Medical Staff Bylaws, please visit http://www.ncmedsoc.org/pages/organized_medstaff/org_medstaff.html.

Questions about these resources may be directed to Melanie Phelps, mphelps@ncmedsoc.org or 919-833-3836.

Physicians from across the state and region will be learning more about accountable care organizations (ACOs) at a seminar hosted by the AMA and NCMS tomorrow at the Hilton Raleigh-Durham Airport in Research Triangle Park. On-site registration is available beginning at 8:00 am. The daylong event, 9:00 am – 3:00 pm, will feature several speakers and a panel discussion, all designed to help physicians and other health care professionals better understand the concept of ACOs and the associated new payment and health care delivery models.

For more than a year, the NCMS has been developing resources to guide physicians in understanding how ACOs and other new models of care will transform health care delivery. At the NCMS Toward Accountable Care webpage, you will find a host of resources that address ACOs and related topics.

More help is available at The Centers for Medicare and Medicaid (CMS) Innovations Center, which was established by the Affordable Care Act to “rapidly test innovative care and payment models and scale up successful models” in order to bring health care improvements at reduced cost. This site offers links to three important programs:

Pioneer ACO Model

Designed for health care organizations and providers that are already experienced in coordinating care for patients across care setting, enabling them to move from a shared savings payment model to a population-based payment model consistent with, but separate from, the Medicare Shared Savings Program. NCMS understands that the revised ACO Shared Savings Program regulations will more closely resemble the Pioneer program.

Advance Payment

Designed to assist emergent ACOs with capital costs.

Accelerated Development Learning Sessions

Provides regional meetings that offer core competencies for ACO development.

One of the four meetings has already been held (Minneapolis, June 20-22). To view videos from the first session, click here.   

Click here to register for one of the following Accelerated Development Learning Sessions (additional information will be provided by CMS):  

• September, San Francisco Bay area, CA
• October, Philadelphia, PA area
• November, Atlanta, GA area

Questions about ACOs may be directed to NCMS Deputy General Counsel Melanie Phelps, mphelps@ncmedsoc.org, or 919-833-3836.