Thursday, October 27, 2011

ACO Summaries Now Available

Three documents summarizing the final rules issued last week for Accountable Care Organizations (ACOs) have been posted to www.apta.org/ACO.

The Medicare Shared Savings Program (MSSP) summary provides the definition of an ACO, an ACO participant, an ACO professional, an ACO provider/supplier, and primary care services. Physical therapists in private practice, home health agencies, skilled nursing facilities, and rehabilitation agencies would be considered for purposes of the ACO regulations an ACO provider/supplier. The summary also discusses ACO agreements with the Centers for Medicare and Medicaid Services (CMS), describes reporting requirements, and details the application process.

A summary of the interim final rule addressing the 5 fraud and abuse waivers that apply to the MSSP are summarized in a separate document. CMS and the Department of Health and Human Services Office of the Inspector General are seeking comments on this interim final rule by January 2, 2012.

Additionally, APTA provides highlights of the Federal Trade Commission and Antitrust Division of the Department of Justice's final joint statement about how the agencies will enforce the antitrust laws as they relate to ACOs. The joint policy statement describes: (1) the ACOs to which it applies; (2) an antitrust safety zone for certain ACOs; and (3) the antitrust review process for ACOs that do not fit into the safety zone.

Comments

From the Private Practice perspective, the ACO question mark boils down to this: Will physical therapists participate as employees or as independent clinicians? Physicians have voted en masse to participate as employees. Record numbers of mergers and acquisitions, especially by large, publicly-owned hospitals, have decreased independently owned physician practices to single digits in my region of the county. Will "integration", in the name of health safety and cost-consciousness, destroy private enterprise in outpatient physical therapy? Tim

Posted by Tim RIchardson, PT on 10/29/2011 10:10 AM
The last 2 documents listed in this article and located on the apta website are the same 2 articles ("Waivers in Connection w/Medicare Savings Program Interim Final Rule") The anti-trust document is identical so I think there may be a missing document for the 3rd piece mentioned. Thanks

Posted by David Knoeppel -> @IR[B on 10/30/2011 8:43 PM
This is a pivotal moment in time for any of the health professions including physical therapy. The primary question for all health professions is to determine how health service delivery and reimbursement can be reformed so that accessible, affordable, effective care can be provided to all children and adults who reside in the United States. In the November 2011 issue of PTJ, physical therapists who are specialists in geriatrics, pediatrics, neurology, orthopedics, private practice, education, policy, law, and ethics from across the country have collaborated to publish a vision for physical therapy for the 21st Century. This publication summarizes the current political-social-economic environment and the essential role that the physical therapy profession contributes to the health of Americans. The challenge for our profession is to speak with one voice of the value of physical therapy to children and adults who have either episodic or chronic disability. The article proposes that our profession define a common, life course approach to physical health. Physical therapists and physical therapist assistants are a potential solution to affordable, accessible care. Our professional members need to be informed of the demands expected from physical therapy and how we can participate in solutions to the current health crisis. Reform in physical therapist and PTA education, development of primary care physical therapy models with reimbursement reform so that physical therapists can address the physical-health needs of a community in collaboration with other health providers are examples of action needed today. Whether in private enterprise or as employees of institutions or ACO's, it is the value of physical therapy to the needs of society that will mark our success. Kathy Sullivan

Posted by Katherine Sullivan -> ?LR[@ on 10/30/2011 11:26 PM

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