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Taylor & Francis
Accountable Care Organizations: Value Metrics and Capital Formation / Edition 1

Accountable Care Organizations: Value Metrics and Capital Formation / Edition 1

by Robert James Cimasi


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Product Details

ISBN-13: 9781466581838
Publisher: Taylor & Francis
Publication date: 06/13/2013
Edition description: New Edition
Pages: 378
Product dimensions: 7.20(w) x 10.10(h) x 0.90(d)

About the Author

Robert James Cimasi, MHA, ASA, FRICS, MCBA, AVA, CM&AA, is chief executive officer of Health Capital Consultants (HCC), a nationally recognized healthcare financial and economic consulting firm headquartered in St. Louis, Missouri, since 1993. Cimasi has more than 25 years of experience in serving clients, with a professional focus on the financial and economic aspects of healthcare service sector entities including valuation consulting and capital formation services; healthcare industry transactions including joint ventures, mergers, acquisitions, and divestitures; litigation support and expert testimony; and certificate-of-need and other regulatory and policy planning consulting.

Cimasi holds a master’s in health administration from the University of Maryland and holds several professional designations: Accredited Senior Appraiser (ASA–American Society of Appraisers), Fellow Royal Intuition of Chartered Surveyors (FRICS–Royal Institute of Chartered Surveyors), Master Certified Business Appraiser (MCBA–Institute of Business Appraisers), Accredited Valuation Analyst (AVA–National Association of Certified Valuators and Analysts), and Certified Merger & Acquisition Advisor (CM&AA–Alliance of Merger & Acquisition Advisors).

He has served as an expert witness in numerous court cases and has provided testimony before federal and state legislative committees. He is a nationally known speaker on healthcare industry topics, the author of several books, including The Adviser’s Guide to Healthcare (AICPA. 2010) and Healthcare Valuation: The Financial Appraisal of Enterprises, Assets, and Services in the Era of Reform (Wiley, 2005), as well as numerous chapters, published articles, research papers and case studies, and is often quoted by healthcare industry press.

In 2006, Cimasi was honored with the prestigious Shannon Pratt Award in Business Valuation conferred by the Institute of Business Appraisers. Cimasi serves on the editorial board of the Business Appraisals Practice of the Institute of Business Appraisers, of which he is a member of the College of Fellows. In 2011, he was named a Fellow of the Royal Institution of Chartered Surveyors (RICS) and serves on the editorial board of the RICS Modus Americas journal. Cimasi is also the current chair of the American Society of Appraisers Healthcare Special Interest Group (ASA HSIG) subcommittee.

Table of Contents

Background and the Path to ACOs
History of Accountable Care
History of Managed Care
ACO: Another Name for Managed Competition
The Path to Accountable Care Organizations
Setting the Stage for ACOs: An Environment Demanding Change
Chapter Summary

Federal ACOs
Purpose of Accountable Care Organizations
Overview of Value-Based Purchasing
The Patient Protection and Affordable Care Act (ACA) and the Medicare Shared Savings Program
Overview and Intent of the MSSP
Related Affordable Care Act Provisions
Center for Medicare and Medicaid Innovation
Value-Based Purchasing Demonstrations
Medical Home Model
Bundling Demonstration Project
MSSP Proposed Rule
Overview of the Main Provisions of the MSSP Proposed Rule
Industry Response
Significant Changes between the MSSP Proposed and Final Rule
MSSP Final Rule
Operational Terminology
Accountable Care Organization
ACO Participant
ACO Provider/Supplier
ACO Professional
Eligible Entities
Structural Requirements
The ACO Agreement
Accountability: The Assignment of Medicare Beneficiaries
Quality and Other Reporting Requirements
Monitoring and Termination
Shared Savings Payments
Subsequent ACO Models under Development
Pioneer ACO Model
Advanced Payment ACO Model Initiative
Accelerated Development Learning Sessions
Proposals for State Payors: Medicaid ACOs
Industry Feedback and Agency Response
American Hospital Association (AHA)
American Medical Group Association (AMGA)
American Medical Association (AMA)
American Academy of Family Physicians (AAFP)
America’s Health Insurance Plans (AHIP)
Physician Group Practice Demonstration Project Participants
Medicare Payment Advisory Commission
Chapter Summary

Commercial ACOs
What Are Commercial ACOs?
Distinguishing between Federal ACOs and Commercial ACOs
Eligible Entities
Structural Requirements
Coordination of Care
The ACO Agreement
Quality and Other Reporting Requirements
Bundled Payment
Partial Capitation
Full Capitation
Global Budget
Tiered Payment Models
Shared Savings and Losses
Chapter Summary

Hypothetical Models for the Development and Operation of ACOs
Structural Features
Federal ACOs
Commercial ACOs
Traditional Structure
Single Healthcare Organization Structure
Transition Challenges
Operational Challenges
Federal ACOs
Commercial ACOs
Competitive Marketplace Challenges
Federal ACOs
Commercial ACOs
Chapter Summary

Impact of ACOs on the Healthcare Industry: Addressing Industry Concern
Regulatory Concerns
Impact on Providers
Antikickback Laws

Capital Finance Considerations for the Development and Operation of ACOs
History of Healthcare Financing
The Financial Crisis: 2007–2009

Financial Feasibility Analysis for ACO Investments
Case Studies: Real Investments of Capital
The Investment Decision
Value Metrics
Cash Flow Analysis
Feasibility Analysis
Payback Period and Discounted Payback Period Methods
AARR Method
Net Present Value
Internal Rate of Return
Further Feasibility Analysis
Chapter Summary

Considerations of Value for the Positive Externalities of ACOs
Defining Value
Value to SOCIETY
Monetary Value
Cost of Healthcare
Productivity Measures
Nonmonetary Value

The Role of the Healthcare Consultant
Economic and Financial Consulting Services Relevant to ACOs
Episodic Services
Continuity Services
Value Metric Services
Financial Feasibility Services
Valuation (Financial Appraisal) Services: Establishing Fair Market Value and Commercial Reasonableness
Selecting and Working with Consultants
Consultant Skills and the Body of Knowledge
Organizational and Strategic Capabilities
The Consulting Process
Data Gathering & Research
The Consulting Analytical Process
Technical Tools
Reporting of Consulting Engagement Deliverables
Chapter Summary





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