Spotlight on ACOs

CMS Administrator Seema Verma on Tuesday (Jan. 29) previewed new demonstrations the agency is working on, including rural telehealth and multi-payer demonstrations, and she said the agency has spent the last year developing a way to increase provider participation in value-based care.

Accountable care organizations, hospitals, doctors and others are asking CMS to push back the Feb. 19 deadline for applications to participate in the revamped Medicare Shared Savings program, with 12 stakeholder groups asking CMS to move the deadline to March 29 and AMGA urging CMS to push it back further to April 19.

The National Association of Accountable Care Organizations says CMS should give ACOs more time to apply to the revamped ACO program after the agency set a Feb. 19 deadline.

CMS on Sunday (Dec. 16) sent an email to stakeholders clarifying that the Center for Medicare and Medicaid Innovation’s work will continue unchanged while Texas v. Azar continues moving through the courts, and the demonstrations run through the Affordable Care Act-created center will keep going as well.

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.