Dive Brief:
- CMS has proposed new rules that would change the nature of the financial incentives ACOs take on when they work with Medicare. The proposed rules would also create a new option for ACOs, allowing organizations to keep up to 75% of what they save, while paying out 75% of what they lose.
- Currently, under rules adopted in 2011, ACOs face penalties after the first three years of participation unless they agree to assume bigger risks in exchange for bigger rewards.
- Under the new proposal, CMS would waive penalties on participating ACOs until after the sixth year, though only if they managed to slow spending during the first two years. CMS is also dropping bonuses from 50% to 40% for ACOs that don't take on more risk after the third year.
Dive Insight:
The new proposed rules are a sign that CMS is willing to make fairly substantial concessions to the industry to expand the Shared Savings Program. Not only is the agency making it easier for participating ACOs to win financially, it's upping the rewards for the biggest risk-takers. CMS also plans to assign the ACO panel of patients at the beginning of the year, a step encouraged by providers.
Giving ACOs time to acclimate to risk seems to be the key to increasing participation. To date, 300 ACOs have joined the program, and all but five chose to forgo the penalty, according to Modern Healthcare. This turns out to have been a good decision, as only a quarter of currently-participating ACOs have meet criteria to earn a bonus, MH notes. Meanwhile, many non-participating providers have told CMS that they would need more than three years to meet the program's goals.
But CMS' proposal also suggests that it's only willing to cede so much ground to recruit new players into the MSSP. To keep ACOs focused on obtaining the most financial benefit from the participation, CMS plans to reduce the potential bonuses they can earn after the third year to 40% from 50% unless they take on more risk. Meanwhile, it's worth noting that CMS hasn't announced any changes in its struggling Pioneer ACO program, whose roster has fallen to 19 participants from 32 just three years ago. It seems the agency will only back down so far.
Want to read more? You may enjoy this story about 4 things providers need to consider before filing for MSSP.