Managed Care

 

Medicare+Choice Regulations Put PSOs on Par With HMOs

MANAGED CARE August 1998. © MediMedia USA
Washington Initiatives

Medicare+Choice Regulations Put PSOs on Par With HMOs

MANAGED CARE August 1998. ©1998 Stezzi Communications
Washington Initiatives

Under the Health Care Financing Administration's Medicare+ Choice Regulations (called "Megaregs" by some wags inside the Beltway), seven different types of managed care arrangements are eligible for risk contracting, including preferred-provider organizations, medical savings accounts and provider-sponsored organizations. Thus, physicians and other providers, such as hospitals and home-health care agencies, can form PSO networks and contract with Medicare, just as HMOs do. So why aren't PSO backers dancing in the street?

For one thing, start-up costs are higher than they would like to have seen. Medicare PSOs will need to have a minimum net worth of $1.5 million, including $750,000 in liquidity. For another, there are numerous administrative mandates. Medicare PSOs will need to comply with already existing requirements on marketing, enrollment, disenrollment, grievances and claims processing and appeal.

How many PSOs are likely to be certified by year's end? Probably not more than 25, by HCFA's estimate.

Meetings

4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014
HealthIMPACT Southeast Tampa, FL January 23, 2015