- Provider organizations are urging CMS to allow Medicare accountable care organizations (ACOs) to continue for three more years without taking on financial risk.
- Under the Medicare Shared Savings Program (MSSP), ACOs that began in 2012 or 2013 face their third contract period in 2019 and will have to move from Track 1 to a risk-based model.
- Currently, 561 ACOs are participating in the MSSP — 82% of which are still in Track 1, according to a letter to CMS Administrator Seema Verma last week.
“Many ACOs remain in Track 1 because they are unprepared to assume risk requiring them to potentially pay millions of dollars to Medicare, which is simply not practical or feasible for most organizations,” the letter says. It was signed by the American Medical Association, Medical Group Management Association, American College of Physicians, National Association of ACOs, Association of American Medical Colleges and Premier Healthcare Alliance.
Providers are notoriously averse to assuming risk, but many believe progress in the shift to value-based care depends on that step.
The groups maintain that ACOs have had to adapt to changes in MSSP regulations and many are just now getting their footing. “While six years may sound sufficient, given the programmatic changes and considerable learning curve for these ACOs, this is not enough time,” the letter says.
They want CMS to let ACOs remain in Track 1 for the next contract period if they meet at least one of the following criteria:
- Generate net savings across four performance years;
- Score at or above the 50th percentile in quality in two of three pay-for-performance years; or
- Raise their overall quality score by at least 10 percentage points over the span of pay-for-performance years.
According to CMS, 11 of 18 Next Generation ACOs earned savings in 2016. These ACOs are based on the Pioneer ACO model and MSSP and take on more financial risk than other ACOs. The payoff is bigger savings from care coordination and care management. Several Next Generation ACOs saved more than $10 million each — a sign that ACOs can achieve savings and improve quality of care.
But ACOs are just one path to value-based care. CMS is also moving ahead with more bundled payments. Last month, the agency launched the Bundled Payments for Care Improvements Advanced model. The program covers 32 clinical episodes — 29 inpatient and three outpatient — and is voluntary as opposed to previous cardiac and hip fracture episode models that were mandatory.
The new program is considered an advanced alternative payment model for MACRA reporting purposes and could be a vehicle for providers looking to opt out of the Merit-based Incentive Payment System track.