Spotlight on ACOs

Center for Medicare and Medicaid Innovation Director Liz Fowler told stakeholders there needs to be uniformity across payers -- including CMS -- in how to gauge their health equity efforts and make them successful.

Center for Medicare and Medicaid Innovation Director Liz Fowler said Thursday (June 3) her center is in the midst of a strategic review of its demonstrations and plans to make conscious choices on how it invests, move to more mandatory models and focus on beneficiaries’ meaningful care relationships.

CMS on Friday (May 21) said it will not extend the Next Generation Accountable Care Organization demonstrations beyond 2021, but it will allow participants in that demo to join the Global and Professional Direct Contracting (GPDC) Model in 2022, even though the agency had previously said it would not accept additional direct contracting applications for next year.

America’s Phyician Groups’ Direct Contracting Coalition is defending the Trump innovation center’s direct contracting demonstrations in the face of concerns from four House lawmakers that the demo moves beneficiaries that opted for traditional Medicare to a Medicare Advantage-like model.

The United States of Care is recommending the Center for Medicare and Medicaid Innovation branch out into more Medicaid-focused models, test Medicare Advantage care options within traditional Medicare and test virtual care in the wake of the COVID-19 pandemic in order to boost health equity.

Hospitals and health systems are pleased with a number of policies proposed by CMS in its fiscal 2022 inpatient hospital pay rule, including provisions allowing accountable care organizations to opt out of additional risk in fiscal 2022, repealing a requirement that hospitals share Medicare Advantage negotiated rates for services and temporarily suppressing certain quality measures the agency determined could have been affected by COVID-19.

Innovation center chief Liz Fowler asked accountable care organizations for patience as the Center for Medicare and Medicaid Innovation evaluates its models, and indicated the center needs to focus on transforming the health care system, not just certifying models to be a permanent part of Medicare.

A handful of accountable care organizations joined dozens of health systems and others, led by America’s Physician Groups, in pushing CMS to reconsider its decision not to accept additional applications for two tracks of the Direct Contracting demo, saying those interested in the demo were ready to apply and the agency’s move is a “serious blow” to those organizations.

Medicare Payment Advisory Commission staff found that rural beneficiaries have a harder time accessing specialty care than do urban beneficiaries, though the two groups reported similar satisfaction with overall care, and that a decline in inpatient admissions preceded rural hospital closures.