Spotlight on ACOs

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.

CMS proposed tweaks to the low-volume exception process for the Merit-based Incentive Payment System, including allowing some otherwise excluded providers to opt-in to MIPS, in a rule released Thursday (July 12), but despite GOP lawmakers' urging, the agency did not lower existing threshold criteria to require more doctors to participate.

Hospitals, doctors and health systems groups are asking CMS to give providers more time to decide whether to participate in the new Bundled Payments for Care Improvement Advanced model, given that providers only received important data and information on the model in the beginning of June.

Stakeholders who work with accountable care organizations pushed back against suggestions from Trump administration officials that ACOs need to take on more financial risk, and one stakeholder said he hopes CMS uses an upcoming proposed rule on ACOs to adjust how it handles regional benchmarking and risk adjustment.

The new director of the Center for Medicare and Medicaid Innovation said Thursday (May 3) that he wants to use his new role to reduce regulatory burdens, promote better sharing of data and encourage value-based care through models that would not necessarily involve providers taking on more risk.