The CMS is proposing an overhaul of the Medicare accountable care organization program in an effort to improve equity. The plan, which includes efforts to get more providers into ACOs and particularly ramp up rural participation, was applauded by ACO groups.
The changes for ACOs in the Medicare Shared Savings Program would give some organizations more time to ramp up to performance-based risk and updated quality reporting that includes adjustments for health equity and measurements for social determinants of health.
The proposed Physician Fee Schedule for fiscal year 2023 released Thursday includes advanced shared savings payments for some ACOs that treat underserved populations and a new calculation approach to benchmarks. The National Association of Accountable Care Organizations called the new benchmark calculations “fairer” and “more accurate.”
The CMS said the changes would result in $650 million in increased shared savings payments to ACOs, and that the updates for 2023 had "some of the most significant reforms since the final rule that established the program was finalized in November 2011."
Another aspect of the proposed rule, however, was met with frustration from physicians.
Providers roundly condemned the conversion factor for fiscal year 2023, with the Medical Group Management Association saying it was "incredibly concerned." The conversion factor would decrease from $34.61 to $33.08 under the proposed 2023 Physician Fee Schedule.
The Surgical Care Coalition said that the cut would harm patient care and called on Congress to intervene. "The current Medicare Physician Fee Schedule is broken," said Joseph Cleveland, chair of the Society of Thoracic Surgeons Council on Health Policy and Relationships, in a statement. "It fails to incentivize collaboration and pits doctor against doctor every year.”
Provider groups cited headwinds including the ongoing COVID-19 pandemic, staffing shortages and rising inflation. Additional financial information for hospitals will come this month with second-quarter earnings reports, but HCA Healthcare recently cut its full-year guidance.
The proposed PFS also includes an effort to "help address the acute shortage of behavioral health practitioners." It would allow licensed professional counselors and other types of behavioral health practitioners to provide their services under general supervision instead of direct supervision under a doctor or nurse practitioner.
In an effort to combat the opioid epidemic, the rule would allow those services to be provided from mobile units, which would especially help homeless and rural populations, the CMS said.
The rule would also increase payment rates to opioid treatment programs and allow for medication to treat opioid use disorder to be prescribed through telehealth services.
The proposed PFS would make some adjustments to Medicare dental coverage, allowing for new treatments such as examinations before organ transplants. The CMS is calling for comment on other dental services that could be covered.
This comes a little more than a week after more than 100 U.S. representatives urged the CMS to expand its dental treatment offerings to all medically necessary situations.
Comments on the proposed rule are due Sept. 6.