Spotlight on ACOs

CMS has pushed back the deadline for providers to update their pay information and claim 2018 alternative pay model bonuses to Dec. 13, after providers asked the agency to get rid of the earlier Nov. 13 deadline or at least push it out to the end of the year.

Long-awaited legislation to tweak accountable care organizations – and in some cases walk back aspects of the administration's program revamp – was recently introduced by Reps. Suzan DelBene (D-WA), Peter Welch (D-VT) and Darin LaHood (R-IL) -- though some lobbyists say it’s unlikely Congress will have the appetite to take up the bill as much of lawmakers’ focus has been on the COVID-19 pandemic.

Accountable care organizations are in favor of increased use of telehealth during the public health emergency but are raising concerns that such e-visits may attach beneficiaries to ACOs without continued engagement.

The National Association of Accountable Care Organizations is urging CMS to extend the Next Generation ACO demo for at least a year -- especially given issues stakeholders have run into with the Direct Contracting model that CMS said could act as the next step for Next Generation ACOs -- and to protect those in the demo from negative side effects of COVID-19.

CMS will mitigate losses by accountable care organizations from January until the end of the COVID-19 public health emergency, the agency says in broad interim final rule released Thursday (April 30), and the agency also says it will exclude beneficiaries’ COVID-19 inpatient care episodes from ACO spending, give ACOs the option not to take on increased risk in 2021, allow ACOs with expiring contracts to extend them through 2021 and use telehealth claims to help assign beneficiaries to the correct ACOs.

Sens. Sheldon Whitehouse (D-RI) and Bill Cassidy (R-LA) are pressing CMS to go further with relief for accountable care organizations as a result of the COVID-19 pandemic and waive the providers’ losses they might otherwise have to repay -- a step that the National Association of ACOs has urged both Congress and CMS to consider.

The National Association of Accountable Care Organizations estimates the COVID-19 pandemic could cost Medicare up to $115.4 billion over the next year, and derail Medicare ACOs.

Stakeholders are urging CMS and lawmakers to make sure the COVID-19 pandemic doesn’t derail providers in value-based pay arrangements, including in accountable care organizations, with some warning of potential mass exits from such arrangements due spending spikes driven by coronavirus care and treatment.

CMS says the revamped Medicare Shared Savings Program Accountable Care Organizations are on track to save $2.9 billion over 10 years, as the agency’s actuary projected when the regulatory overhaul was finalized, but the National Association of ACOs raises concerns about the program’s lack of growth because it says fewer new ACOs are joining the program than in past years.