Spotlight on ACOs

Radiation oncologists are concerned about the possibility of mandatory participation in a radiation oncology demonstration after HHS Secretary Alex Azar indicated such a model was on the way.

CMS says about 93 percent of eligible providers in the Merit-based Incentive Payment System received a bonus for their 2017 performance and the vast majority avoided a pay cut -- though CMS Administrator Seema Verma says in a blog post that she expects performance in the program will change as the thresholds are harder to meet.

CMS says about 1,300 entities have agreed to participate in the Trump administration's first advanced alternative pay model, the Bundled Payments for Care Improvement Advanced, and Christina Smith Ritter, the director of the Patient Care Models Group at CMS' innovation center said that participation reflects an understanding that value-based pay is where the health care system is heading.

Rep. Suzan DelBene (D-WA) is drumming up support for a letter that will ask CMS to adjust the low-volume threshold in order to include more providers in the Merit-based Incentive Payment System as part of the final 2019 physician fee schedule – an agency move that would be supported by some stakeholders like Premier and the American Medical Group Association even though the American Medical Association and others want CMS to finalize the exemption as proposed.

The National Association of Accountable Care Organizations and Institute for Accountable Care say CMS should back away from cuts to the shared savings rate for ACOs in its new model, give providers at least three years and as many as five before they need to take on risk and allow beneficiary risk scores to change by up to 5 percent during ACO contracts.

House Ways & Means Chair Kevin Brady (R-TX) and health subcommittee Chair Peter Roskam (R-IL) welcomed CMS' efforts to revamp Medicare accountable care organizations and said they appreciate the agency's proposal to extend current contracts by six months to prevent the mass exit of ACOs -- but they also asked the agency to reconsider reducing shared savings down to 25 percent for those ACOs that don't take on risk.

CMS innovation center director Adam Boehler on Thursday (Aug. 30) suggested accountable care organizations opting not to participate in the overhauled Medicare Shared Savings Program could pursue other value-based care avenues, including a direct-provider contracting initiative or bundled pay.

CMS is proposing a major revamp of the Medicare Shared Savings Program Accountable Care Organizations, including a plan to give new ACOs only two years before they must start sharing both savings and losses with the agency.

The National Association of Accountable Care Organizations wants CMS to create a direct channel for ACOs to report suspected fraud and abuse, but CMS Center for Program Integrity Director Alec Alexander, when pressed on that at a recent hearing, said there are already methods for providers to report such concerns.