Survey: 13% of Hospitals Plan to form ACOs

Only 13 percent of hospitals reported participating in an accountable care organization (ACO) or were planning to participate in an ACO within a year, while 75 percent of hospitals were not considering ACO participation, according to newly published results from a 2011 survey by researchers at The Commonwealth Fund and the Health Research and Educational Trust. The most common ACO governance models were joint ventures between physicians and hospitals, 51 percent, and physician-led governance, 20 percent, according to the survey of more than 1,600 hospitals. Another 18 percent of ACOs have a hospital-led governing body. Only 2 percent are led by payers. The survey found that hospitals participating in ACOs or preparing to participate were more likely to be larger not-for-profit and teaching organizations, located in large urban areas, and belong to a health system, compared with hospitals that were not planning to be part of an ACO. Results also suggest that many hospitals that are currently pursuing an ACO strategy do not yet have the capabilities needed for population health management. Only one of five hospitals participating in or preparing to join an ACO reported using predictive tools to identify patients at high risk of poor health outcomes or high resource use.

CMS Finalizes New Regulation to Standardize Electronic Funds Transfer (EFT)

The Centers for Medicare & Medicaid Services (CMS) announced that the interim final rule that adopts healthcare electronic funds transfer (EFT) standards is now a final rule currently in effect. According to CMS, the standards for EFT could reduce administrative costs for physician practices and others by up to $4.5 billion over the next ten years. The rule is the second in a series of regulations mandated by the administrative simplification section of the Affordable Care Act. The final rule outlines two standards that health plans must comply with in order to use EFT to transmit healthcare claim payments to providers.

  1. First, health plans are required to use a standard format when ordering, authorizing or initiating an EFT with their banks.
  2. Second, the rule outlines the data content of the EFT.

Health plans and other covered entities must comply with the provisions of the EFT rule by Jan. 1, 2014. However, CMS indicates that health plans are permitted to use the EFT standards with willing trading partners before that date. Practices not already receiving EFT payments should contact their practice management system software vendor and health plans to discuss incorporating this transaction into their claims revenue cycle workflow.

Read full regulation in the federal register.