“The Pioneer Model is an opportunity for those organizations that have already adopted significant care-coordination processes to move further and faster into seamless, coordinated care by utilizing alternative payment mechanisms,” Dr. Richard Gilfillan, acting director of the innovation center, said in a news release.
The Innovation Center is also accepting public comments on whether it should offer an advance payment initiative, which would allow certain ACOs participating in the Medicare shared-savings program to access a portion of their savings in advance. The idea is to help providers make the necessary staffing and infrastructure investments for their ACO to be successful, according to the CMS, which will accept public comments until June 17.
And the agency said it will host free “accelerated development learning sessions” for providers who want to learn more about the necessary steps in becoming an ACO. The CMS said there will be four sessions in 2011, and that each one will center on a core competency for an ACO, including improving care delivery to improve quality and reduce costs; using health information technology and data resources; and building capacity to assume and manage financial risk.
Ten physician groups that previously tested accountable-care-style payments could be suitable Pioneer applicants, CMS Administrator Dr. Donald Berwick told reporters as the initiatives were announced. The 10 groups are finalizing contracts to extend the prior five-year test for two years, incorporating elements of proposed accountable care rules.
Berwick said the new initiatives were not an admission Medicare's proposed accountable care rules would be unworkable for major providers. Major physician associations have rejected proposals in letters to Berwick and some have said they won't participate without changes. Berwick said plans announced today were underway prior to the proposed rule, which was released in late March.
“The criticism is comment,” he said. “We're welcoming that. We're in a comment period. We had a proposed rule out there we're getting terrific feedback. Now we're understanding a lot about what's going on and we're going go to meld that input into a better final rule,” he said.
“I see these as complementary” he said. “This program from the Innovation Center is going really to help the early comers get started sooner its gong t help novices learn faster and its going to help those who need a little bit of assistance to capitalize the effort get that capital.”
Berwick said the effort to launch accountable care organizations is on schedule.
Berwick said officials would take a hard look at comments on quality measures and minimum savings required in order for providers to earn financial incentives. Providers have criticized the proposals as costly and difficult to achieve.
“This is a voluntary program, so we know that we have to create incentives and requirements that are attractive to potential participants,” said Jonathan Blum, the deputy administrator and director of the Center for Medicare. “But as Dr. Berwick laid out we also have to balance other considerations, beneficiaries and the trust fund.”
After the CMS’ announcement, the American Medical Association released a statement from the group’s immediate past president, Dr. J. James Rohack, who said the agency’s ACO initiatives move in the right direction, but that the agency should do more to make sure all physicians who are interested can participate in these organizations.
“The benefits of this new care delivery model cannot be fully realized unless physicians in all practice sizes can be involved,” Rohack said in the statement. “According to the AMA physician practice survey, 78% of office-based physicians in the United States work in practices with nine physicians or less. The AMA has encouraged CMS to provide assistance for physicians in small practices, including start up capital and small-business loans, to meet the large initial expenses that will come with participation in ACOs.”
