Accountable Care Organizations: Proposed Regulations Finally Released

Outline

1. Proposed ACO regulations
   1. ACO governance and legal organization options
   2. Are 5000 minimum ACO beneficiaries sufficient? Is $1.75 million start-up cost realistic?
   3. Influence of MedPac’s recommendations on the proposed ACO regulations
   4. One-sided risk parameters
   5. Specific requirements regarding primary care physicians and other ACO physicians
   6. Medicare beneficiary's freedom of choice of physicians and other providers and controversial data-sharing patient opt-out right (ACO disclosure requirements and implications for ACO shared savings and two-sided risk model)
   7. Two-sided risk parameters and potential impact of state HMO/insurance law
2. Impact of other federal laws on ACOs and proposed waivers/exceptions
   1. Antitrust law
   2. Anti-kickback laws
   3. Civil monetary penalty law
   4. Tax law
3. Provider payment strategies
   1. Reimbursement continuum
   2. Payment models and developmental capabilities
   3. Bundled payments and episodes of care
   4. Combined bottom-line payment model
   5. Continuum of clinical care management
   6. Provider-payer care coordination focus

Benefits

The panel will review these and other key questions:

• What factors should healthcare providers consider when assessing participation in ACOs?
• What does the proposed rule require for ACOs to take responsibility for improving the quality of care while lowering costs in order to receive a share of the resulting savings?
• What are the legal obstacles that healthcare providers must overcome to participate in ACOs?

Following the speaker presentations, you'll have an opportunity to get answers to your specific questions during the interactive Q&A.