Accountable Care Organizations

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Accountable Care Organizations (“ACOs”) are clinically and financially integrated health care entities composed of a group of providers who are jointly responsible for the quality, cost and overall care of a patient population.  There are Medicare ACOs defined under the Affordable Care Act of 2010 and commercial payor ACOs.  They may take a variety of...Read More

Accountable Care Organizations ("ACOs") are clinically and financially integrated health care entities composed of a group of providers who are jointly responsible for the quality, cost and overall care of a patient population.  There are Medicare ACOs defined under the Affordable Care Act of 2010 and commercial payor ACOs.  They may take a variety of forms such as a single integrated delivery system or a large multi-specialty physician group that contracts with other provider entities, including an acute care hospital and a home health provider.

Medicare ACOs must have a formal legal structure with established mechanisms for shared governance and the receipt and distribution of shared savings which are earned by meeting Medicare-adopted quality metrics and Medicare-established cost saving targets.  Medicare Shared Savings Program/ACO rules, the established waivers of some federal fraud and abuse laws as applied to ACOs and the newly published IRS expanded Rev. Proc. 97-13 safe harbor are complex and nuanced.  Since the passage of the Affordable Care Act in 2010, Hall Render attorneys have been studying, analyzing and advising on all aspects of ACOs.

Specifically, Hall Render attorneys have provided advice and guidance to hospitals, physician groups and national and regional health systems on matters relating to the formation, organization and operation of ACOs.  We have formed rural ACOs, which consist of hospitals, federally qualified health centers, rural health clinics and independent physician groups, created the ACO legal entity, drafted its governance documents and prepared its participation and provider agreements.  We have prepared and submitted ACO applications to the Medicare Shared Savings Program and assisted other ACOs to correct application deficiencies raised by CMS.  We regularly assist ACO clients with ongoing operational issues and questions concerning ACO governance, participant relations and commercial contracting.  We continue to work with new and emerging ACOs, assisting these ACOs with the regulatory and practical complexities that confront each developing ACO.

In addition to our experience with ACOs and the Medicare Shared Savings Program, we have extensive experience in developing and forming complex and innovative provider entities and arrangements.  This experience provides us with a thorough understanding of physician and provider alignment, clinical and operational integration and the development of performance metrics.

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Areas of Focus

  • Accountable Care Organizations (ACOs)
    • ACO Regulations
  • ACO Quality Measures
  • Notice 2014-67 Rev. Proc. 97-13
  • Patient Protection and Affordable Care Act
  • Population Health Management
  • Quality Metrics
  • Risk Bearing Model
  • Shared Losses/Financial Risk
  • Shared Savings Program
  • Waivers