Spotlight on ACOs

CMS Administrator Seema Verma said stakeholders can expect more Center for Medicare and Medicaid Innovation (CMMI) models to be mandatory and for all upcoming payment models to include resources for state Medicaid adoption as she teased new rural health models and a long-awaited radiation oncology model in a speech to the National Association of Accountable Care Organizations (NAACOS) on Thursday (April 25).

HHS on Monday (April 22) announced new models for primary care -- Primary Care First and Direct Contracting -- that are designed to encourage primary care providers to take on more financial risk for the outcomes of their patients and are projected to encompass a quarter of all fee-for-service Medicare beneficiaries.

The National Association of Accountable Care Organizations (NAACOS) recently sent a letter to CMS asking the agency to make a tobacco-use quality measure, which was changed by agency, into a pay-for-reporting measure rather than a pay-for-performance one since NAACOS said CMS didn’t adequately communicate changes and ACO performance scores have suffered.

CMS will again ask stakeholders for feedback on how to reduce regulatory burden, according to CMS Administrator Seema Verma, even as work on two separate CMS burden-reduction rules continues.

Piggybacking on providers’ requests, a bipartisan group of four House lawmakers is pressing CMS to delay the Feb. 19 deadline for applications to participate in the revamped accountable care organization program that kicks offs in July.

An analysis from the National Association of Accountable Care Organizations says CMS’ changes to the threshold for differentiating high-revenue and low-revenue ACOs is estimated to keep more physician-affiliated ACOs and those affiliated with Federally Qualified Health Centers from having to take on risk at a faster rate under the new Medicare Shared Savings program rules, but NAACOS says concerns remain that the system could keep ACOs from integrating specialty care.

CMS on Friday (Dec. 21) finalized its overhaul of the Medicare Shared Savings Program by shortening the amount of time that accountable care organizations can participate in an upside-only model and reducing the shared-savings rate for ACOs that are not taking on financial risk.

The White House budget office on Tuesday (Nov. 13) began reviewing HHS’ request for feedback on ways to revamp the Health Insurance Portability and Accountability Act to boost efforts to coordinate care.

HHS Secretary Alex Azar on Thursday (Nov. 8) said CMS plans to both bring back the mandatory bundled-pay models the agency canceled last year and look at new models, including for radiation oncology.