In their meeting held yesterday here in Washington, DC, the Medicare Payment Advisory Commission (MedPAC) voted 15 to 1 in favor of advising CMS to implement preauthorization on physicians whose ordering patterns exceed those of their peers. Physicians with average ordering patterns, on the other hand, would only be subject to prenotification. The justification for this move is that the top 10% of physicians are responsible for 50% of advanced imaging exam ordering, with a significant amount attributed to self-referral.
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Last Thursday, CMS released the highly anticipated proposed rule governing the Shared Savings program, providing much needed clarity around who can participate, how patients will be assigned to Accountable Care Organizations, and how bonus payments will be calculated. The pilot phase of the program will begin Jan. 1, 2012, and represents the most ambitious of the health reform provisions aimed at transforming the delivery system. As the specifics of the program are both highly complex and tremendously nuanced, we have compiled a host of resources to help our members understand both the mechanics and implications of the program as defined by the new rule.
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