Spotlight on ACOs

CMS Deputy Administrator for Innovation and Quality Patrick Conway said the agency is considering how certain Center for Medicare and Medicaid Innovation models and demonstrations might work together.

The long-awaited proposal to revamp Medicare's physician-pay system doesn’t count arrangements in Medicare Advantage toward the payment calculation in the Alternative Payment Model Incentive Payments program, but CMS proposes to use MA arrangements, as well as pay arrangements from private and Medicaid plans, to determine whether providers qualify as alternative payment models under the pay scheme.

Accountable care organizations allege CMS officials are being “duplicitous” by ostensibly accepting providers' advice to limit the extent to which ACOs must compete against their own past performance while at the same time designing the policy change to reduce Medicare spending, instead of making it budget neutral.

The White House budget office last Friday began reviewing CMS' major proposed rule on the new Medicare physician-pay system, and some lobbyists speculate the agency will propose the rule late this week while Congress is still on recess.

When CMS officials announced that they met value-based pay goals, they counted one-sided accountable care organizations as alternative pay models, so ACO lobbyists say they are urging CMS to also consider ACOs that don’t accept the risk of penalties as alternative pay models in the upcoming physician pay system.

A bipartisan group of House committee leaders believes CMS in the draft 2017 Medicare Advantage and Part D Call letter implicitly recognizes that MA plans could qualify as alternative payment models under a new physician system, though one analyst said CMS has a long way to go before counting Medicare Advantage as an alternative pay model.

Physician lobbyists plan to pressure CMS to loosen its interpretation of alternative payment models by making their case to the panel that advises the agency on those pay models, and the American Medical Association might seek outside legal help to fight CMS’ stance on what constitutes sufficient financial risk, an AMA executive said Wednesday (Feb. 24).

CMS officials indicated this week that they don’t plan to count bonus-only accountable care organizations as alternative pay models in the upcoming physician pay system.

CMS on Thursday (Jan. 28) proposed changes to ACO performance measures that the agency says would increase bonuses to accountable care organizations by calculating benchmarks based on local health care spending and by limiting the extent to which ACOs must compete against their own past performance.