Spotlight on ACOs

Although CMS wants to push more providers into risk-bearing accountable care organizations, Brookings Institution scholars and many providers say the agency could inadvertently do the opposite by making it possible for providers in ACOs that don't accept the risk of penalties to get much larger bonuses than providers in risk-bearing ACOs.

The IRS denied a commercial accountable care organization tax-exempt status earlier this year -- though ACOs participating in the Medicare Shared Savings Program are eligible for tax-exempt charitable status -- and some say the decision raises questions about how different types of ACOs are treated as far as their tax status.

A bipartisan group of 70 House lawmakers is pressing CMS to waive, to the extent possible, certain restrictions on hospitals and post-acute care providers when they participate in alternative pay models that accept the risk of penalties.

CMS’ recent policy reversal that lets accountable care organizations participate in the Comprehensive Primary Care Plus (CPC+) demonstration bolsters the case for letting ACOs participate in other pay-for-performance demonstrations, including the Comprehensive Care for Joint Replacement demo and the Bundled Payments for Care Improvement initiative, a provider consultant says.

Mental health advocates say CMS hasn't adequately factored behavioral health into its aggressive efforts to create Center for Medicare and Medicaid Innovation demonstrations that test new value-based payment models.

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.