Spotlight on ACOs

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.

White House staff are reviewing a Medicare rule on the Comprehensive Care for Joint Replacement model that accounts for “extreme and uncontrollable circumstances” hospitals in the program might face, and lobbyists familiar with the bundled-pay model says the rule will likely finalize provisions aimed at helping providers affected by natural disasters, such as last year's hurricanes.

CMS is considering giving Medicare beneficiaries a stipend that they could use to pay for subscriptions to primary care practices that don’t otherwise participate in Medicare, according to James Keese, executive director of the Direct Primary Care Coalition.