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CMS Names First ACOs for Shared Savings Program
Early this month, the Centers for Medicare and Medicaid Services (CMS) announced the first 27 accountable care organizations (ACOs) that will participate in Medicare's Shared Savings Program. ACOs are voluntary groups of hospitals, physician organizations, long-term care providers, and others that have agreed to work together to improve the health of a designated group of patients. Another round of such ACOs will be selected from 150 applicants to begin operating July 1. In December, CMS named 32 groups Pioneer ACOs—selected because they have already had experience coordinating care among different providers and assuming financial risk for a designated population. In its announcement, CMS deputy administrator Jonathan Blum cited the "phenomenal" response to the Shared Savings Program, noting that applications came from around the country and from organizations of varying size and composition. In particular, Blum noted that more than half of the organizations in the 27 new ACOs are led by physician groups, which should assuage concerns voiced by some that the organizations would be dominated by large hospitals systems.

Quality Measures Proposed for Stage 2 "Meaningful Use" 
Proposed measures of clinical quality for use in Stage 2 of the federal government's meaningful use program are available for review and public comment through May 7. The measures are part of a set of the requirements that hospitals and other heath care providers must meet to demonstrate they are making "meaningful use" of electronic health record systems. Those that meet these criteria will qualify for incentive payments under the Medicare and Medicaid programs. Observers have noted that while the Stage 1 measures focused on the types of data collected by the EHRs, the new proposed measures require providers to demonstrate that EHRs are being used to engage patients and exchange information among providers.

Medical Groups Publish List of Treatments to Avoid Ordering
As part of an effort sponsored by the American Board of Internal Medicine to avoid unnecessary tests and procedures, nine medical specialty groups last month published a list of 45 procedures that physicians should not automatically order. The list includes prescribing antibiotics for mild to moderate sinus conditions; imaging for low back pain within the first six weeks of treatment and when no red flags are present; and treating tumors in end-stage cancer patients who have not responded to multiple therapies and are not eligible for experimental treatments. The effort, dubbed "Choosing Wisely," seeks to encourage conversations between physicians and patients about evidence-based care. It also seeks to increase physicians' awareness of their role as stewards of the nation's health care resources.

Community-Based Organizations Seek to Reduce Readmissions
This spring, as part of the Affordable Care Act's Community-Based Care Transitions Program, 30 community-based organizations will launch efforts to reduce hospital readmissions. The care transitions program allocates $500 million for these efforts over five years, with most of the money going to community-based organizations (CBOs), such as area agencies on aging and other social support groups that have traditionally provided services such as home-delivered meals, transportation, and counseling for elderly and disabled adults. With the new funds, the organizations will reach out to patients who have been identified by hospitals as being at high risk for readmission. Among many activities, CBO staff will meet patients at the time of discharge, talk to their providers, and visit their homes to identify social and environmental factors, such as poor nutrition and risk of falls, that could trigger avoidable complications and lead to readmissions. After two years, the projects must achieve a 20 percent reduction in the number of 30-day readmissions to be eligible for further funding.

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