- Nearly three-fourths of accountable care organizations will leave the Medicare Shared Savings Program next year if they are forced to assume risk, according to a new survey by the National Association of ACOs.
- Of the 82 ACOs the group surveyed, 71% said they will likely exit the MSSP if they have to start taking on risk. About 6% said they are unsure, while 23% indicated they would likely remain in the program.
- Under the Affordable Care Act, ACOs that entered MSSP Track 1 in 2012 or 2013 are expected to convert to a risk-based model in their third contract period, which starts next year.
“These results paint a bleak future of what will happen if the government keeps its mandate to push ACOs into risk,” Clif Gaus, president and CEO of NAACOS, said in a statement. “It’s naive to think ACOs that aren't ready will be forced into risk in what is ultimately a voluntary program. The more likely outcome will be that many ACOs quit the program, divest their care coordination resources and return to payment models that emphasize volume over value.”
While the survey involved just those ACOs that will face risk requirements next year, the fallout from forcing risk on ACOs will be an ongoing issue as more of them approach their third agreement periods, NAACOS warns.
ACOs’ reasons for not being prepared to assume risk varied. The three top challenges cited were the amount of risk assumed, the possibility of unexpected changes to the ACO model or CMS rules, and the desire for more predictable financial projections.
NAACOS wrote to CMS Administrator Seema Verma in February, urging the agency to allow some ACOs to remain in Track 1 for a third contract period before shifting to a two-sided risk model. The exception would apply to ACOs that generate net savings across four performance years, ACOs that score at or above the 50th percentile in quality in two of three pay-for-performance years and ACOs that improve their overall quality score by 10 or more percentage points over their pay-for-performance years.
Providers’ lack of willingness to take up risk is a pervasive problem for the value-based care movement.
Studies have showed mixed results with ACOs. A recent analysis by Avalere found the MSSP missed federal cost-savings projections from 2010, when the ACA was enacted, by a wide margin. The Congressional Budget Office estimated the program would save Medicare $1.5 million from 2013 to 2016. Instead, it raised federal spending by $384 million, Avalere said.
A pair of studies published last year in JAMA Internal Medicine were more favorable. In one study, post-acute spending at 114 ACOs dropped 9% from 2012 to 2014. The other study showed savings at two ACOs in Colorado and Oregon, despite major differences in their structures.