- CMS on Thursday released its final rule for the Medicare Shared Savings Program, intended to both encourage provider participation and bolster the program's long-term viability.
- As expected, the regulations adopt a third-track option with higher risks and rewards; they also allow providers to enter a second three-year period in the first track, in which they can receive rewards for hitting targets but will not be penalized for missing them.
- The rule also includes a provision that resets benchmarks in the second agreement period to reflect performance during the first agreement period for all tracks.
The new rule clocks in at almost 600 pages but so far, analysts haven't turned up any big surprises—The Advisory Board's Eric Cragun remarked on Twitter than the minimal number of changes from the proposed rule would likely keep most ACOs from dropping out. The regulations should provide some clarity for ACOs currently hanging in limbo: "A whole lot is riding on the final rule and whether or not the ACO has a better chance of achieving savings and improving care," Clif Gaus, CEO of the National Association of ACOs, told Modern Healthcare.
In particular, the first-track extension given to providers is a big agency investment in the attractiveness and viability of the program.
"Shifting from fee-for-service to accountable-care models takes time," CMS chief medical officer Dr. Patrick Conway said. "That is a long-term transition and can certainly take more than three years. We're really trying to meet providers where they are."
On the finalized third track: CMS Deputy Administrator Sean Cavanaugh told Modern Healthcare that this track is "very much modeled" after the Pioneer ACO model, but shares some commonalities with the Next Generation ACO the agency proposed earlier this year. According to CMS, the risk for this model would be equally-weighted for savings or loss at 75%, unchanged since the December proposal. Track three ACOs will also have a fixed population of beneficiaries.
To come later this year: Adjustments to benchmarking and rebasing methodology, widely called for (and expected) by providers to account for regional population differences.
A few other insights from the wonk world:
As anticipated, the agency also finalized rules for modifying the ACO participant lists and put an emphasis on primary care, elevating the work of NPs and PAs to the first step of the attribution process, according to Aledade's Travis Broome.