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Small ACOs to get a head start

Small accountable care organizations that hope to obtain an advance on future Medicare revenue will get an early look next month at the application, a few weeks before its release.

That practical concession from federal officials looks from the outside something like a scramble to draft, release and adopt rules. It also underscores the fretful hope among policymakers that accountable care will work not just for large, wealthy and well-organized health systems, but for small medical groups and rural hospitals.


Deadlines for to apply for the advance payments, just released by the Center for Medicare and Medicaid Innovation, give small physician groups and hospitals roughly one month—Jan. 3 to Feb. 1—to complete the first round of applications. The formal application will be released on Jan. 3. The second round of applications will be accepted March 1 to 30.

But to help doctors and hospital executives prepare, federal officials will publish online the questions to be included on the application in mid-December.

Robert Berenson, an Urban Institute fellow, and Rachel Burton, an institute research associate, give an excellent summary of accountable care—and tension over its growth—in a recent Robert Wood Johnson Foundation paper.

Medicare's accountable-care program, scheduled to launch in two waves next year, and the Medicare Pioneers, or more experimental and developed ACOs, offer providers financial incentives to improve quality and save money.

Berenson and Burton ask whether the goal of these programs is to test if the model “to see if it is broadly scalable to diverse providers” to see how much Medicare saves and how quickly; or “to move as many providers as possible into the program as soon as possible to satisfy political pressures to slow growth in Medicare spending.”

CMS estimated 50 to 270 groups could be designated Medicare accountable care organizations, the authors noted.

Under the advance payment program, small medical groups and hospitals can earn an upfront fixed payment plus an upfront variable payment and another monthly payment based on size. Policymakers designed the program to provide a capital infusion for small ACOs with fewer resources.

You can follow Melanie Evans on Twitter: @MHmevans.


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