Tomorrow the United States Supreme Court will hear oral arguments regarding states' authority to limit uses by pharmaceutical companies of physician prescription records for marketing. We discussed this issue in November on a blog post when the Vermont data-mining restrictions were found unconstitutional as a violation of free speech. For more on this battle headed to the Supreme Court, see this article in the New York Times.
On March 31, 2011 the Centers for Medicare & Medicaid Services (“CMS”) released the much-anticipated proposed regulations for the creation of Accountable Care Organizations (“ACOs”), which were published in the Federal Register on April 7. ACOs are a key component of the Patient Protection and Affordable Care Act (“PPACA”) and are referenced in PPACA as part of the Medicare Shared Savings Program. Section 3022 of the Patient Protection and Affordable Care Act, Pub. L. 111-148 (Mar. 23, 2010), codified at 42 U.S.C. 1395jjj. Following the launch of the ACO program on January 1, 2012, CMS expects 5 million Medicare beneficiaries to eventually receive care through an ACO.
ACOs are coordinated healthcare delivery systems in which provider reimbursements are tied to quality measures and overall reductions in the cost of healthcare. In theory, ACOs will be able to maximize value by using a patient-centered team approach to care. In the ACO model, providers regularly communicate and collaborate on various aspects of patient care, ensuring continuity and consistency in care delivery. This approach stands in stark contrast to many current delivery models in which providers operate in silos, often creating disjointed or uncoordinated patient care.
Structurally, an ACO will consist of a group of healthcare providers – physicians, physician groups, hospitals, and other suppliers of health services or provisions – contracting with each other and with CMS to provide comprehensive care for patients. While providers will still receive Medicare fee-for-service payments, the ACO will share in any savings it achieves for the Medicare program. At the same time, however, ACOs would be liable for any losses to Medicare. This “blended” reimbursement model eliminates incentives for overutilization inherent in a traditional fee-for-service system, yet also disincentivizes underutilization because some fee-for-service reimbursement remains.
Continue Reading...Over the past few weeks, Nevada-based Corporate Controllers Unit, Inc. ("CCU") has been engaged in a mail solicitation scam regarding Colorado Secretary of State filing fees. CCU has sent thousands of letters to Colorado addresses, each of which claims a $225.00 "annual fee" is due for filing a company's periodic report with the state. The letter has generated confusion among business owners because it looks like an official government document. Its reliability is bolstered by citations to Colorado law, intimidating terms such as "noncompliant" and "delinquent," and a logo resembling a government seal. Despite these misleading apparent marks of credibility, CCU has no authority to solicit fees on behalf of any government agency.
Colorado Secretary of State Scott Gessler issued a warning Monday regarding CCU's deceptive mail solicitations. Secretary Gessler reminded business owners that although the state does require most entities to file periodic reports annually, the cost for most businesses is only $10.00. You can find additional information on this issue at the Colorado Secretary of State's website.
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