- Accountable care organizations want more help from the Trump administration to gain a more solid financial footing amid the novel coronavirus pandemic.
- ACOs, whose payments are tied to spending and patient health benchmarks, are asking CMS to give them the option of protection from any financial losses for a reduced shared savings rate no lower than 40%, according to a Thursday letter nine organizations sent to CMS.
- The coalition, including the National Association of ACOs and the American Medical Association, also lobbied CMS to push back the deadline for ACOs to decide whether they will remain in the Medicare Shared Savings Program from June 1 to Oct. 31. Value-based care advocates have warned CMS may see a mass exodus of providers from the program if the June deadline holds, as they seek to avoid losses stemming from COVID-19.
Providers in value-based arrangements are worried worsening patient outcomes due to COVID-19 could compromise their performance, leading to unforeseeable financial penalties in certain Medicare and commercial models and setting back the decades-long shift to value-based care.
More than half of providers in two-sided risk arrangements anticipate losses that have to be paid back to payers due to a surge in COVID-19 patients and the higher costs needed to treat them, according to group purchasing organization Premier, which also signed Thursday's letter. At the same time, doctors and hospitals are struggling with a depression in fee-for-service payments brought on by canceled or delayed non-essential procedures.
"Many ACOs remain concerned about the unpredictability and potential for catastrophic losses for performance year 2020," the letter reads.
CMS released a rule earlier this month proposing a series of changes to MSSP, including canceling the 2021 application cycle to give ACOs whose participation is set to time out this year the option to extend. The groups are asking CMS to reverse that decision.
Pushing back the June deadline for MSSP will give providers more data to inform the decision, including ingesting a series of new rules meant to mitigate the pandemic, and more insight into a potential resurgence of the coronavirus in the fall.
The groups also want CMS to pay them shared savings, or advanced bonuses, as soon as possible. Those payments are typically received late summer or early fall.
The Trump administration has already lowered some burden on ACOs amid research finding the pandemic is causing providers to seriously consider exiting the models. CMS has paused some reporting requirements for value-based initiatives and pledged ACOs won't be held financially culpable for lower-than-expected health outcomes in their patient populations from COVID-19. CMS is also letting ACOs remain at the same level of risk for another year, instead of automatically bumping them up to the next risk level.