BY VIRGIL DICKSON | OCTOBER 17,
2018
Accountable care organizations have experienced a change of heart
and say they will likely stay in the Medicare Shared Savings Program even if
that means taking on downside financial risk sooner, according to an
association survey released Tuesday.
Nearly 50% of the ACOs surveyed by the National Association of
ACOs said they would participate in MSSP if the CMS restructures the program
and eliminates some tracks that don't include financial risks for the
organizations.
That's a stark change from this spring, when 71% of early MSSP
adopters said that they were likely to leave the program if
forced to take on more risk. Now, only 36% say they'll likely exit the program,
and 16% are neutral on their future commitment.
The survey was part of the National Association of ACOs' comment
letter on the CMS' proposed rule to
restructure the MSSP program. All in all, the agency received more than 400
comments before Tuesday's deadline.
The new attitude appears to stem from some proposed tweaks to the MSSP program, including a change to how the CMS will assign them patients.
Providers have complained for years about the current process, since the CMS typically tells physicians which of their patients fall under the ACO process at the end of the year. Those patients' outcomes are used to determine whether the ACOs improved care quality while reducing costs.
The agency maintains that process prevents doctors from choosing only their healthiest patients to participate in their ACOs and skewing the results.
Now, the CMS has suggested giving ACOs a choice for beneficiary assignments. The providers can either stick with the current retroactive assignment process or know which patients they will be accountable for ahead of time. Physicians will be allowed to change their assignment process each year.
That's the biggest opportunity for ACOs, according to Clif Gaus, president and CEO of the association.
"The proposed program flexibility would provide ACOs with more choices and let them move to a risk-based model without requiring them to move from retrospective to prospective assignment, as is currently the case with moving to MSSP Track 3 or Track 1+," he said in a comment letter.
ACOs also praised proposals to let them use telehealth services and allow beneficiaries to access skilled nursing facilities without a hospital admission first.
The CMS also suggested allowing ACOs to pay their patients up to $20 for doctor visits or offer other incentives.
But ACOs are still worried about taking on negative financial risks.
Under Obama-era regulations, ACOs that started in Track 1 in either 2012 or 2013 are supposed to move to a risk-based model by the third contract period, which begins next year.
The CMS wants to cut the maximum amount of time ACOs can spend in upside-only risk. If the rule is finalized, first-time ACOs will get two years without financial penalties and they will only receive 25% rather than 50% of their savings. ACOs that participated in MSSP before will only get one year of upside-only risk.
"Our members have expressed concern that limiting upside agreements to two years does not take into account operational challenges in transitioning into an essentially new MSSP program," Dr. Jerry Penso, president and CEO of AMGA said in a comment letter. "We believe CMS should offer a third, upside only year."
ACOs also criticized the CMS for not providing information about performance or benchmark target goals quickly enough. That leaves them "functionally blind" and unable to change course if they're not improving costs or quality, according to Thomas Nickels, executive vice president of the American Hospital Association.
"At a time when ACO participants need to determine how to invest any returns or how to alter their care delivery to achieve savings and improve quality, they have no visibility into whether they even have any returns to invest or whether changes they have already made have produced cost reductions or quality gains," he said in a comment letter.
The new attitude appears to stem from some proposed tweaks to the MSSP program, including a change to how the CMS will assign them patients.
Providers have complained for years about the current process, since the CMS typically tells physicians which of their patients fall under the ACO process at the end of the year. Those patients' outcomes are used to determine whether the ACOs improved care quality while reducing costs.
The agency maintains that process prevents doctors from choosing only their healthiest patients to participate in their ACOs and skewing the results.
Now, the CMS has suggested giving ACOs a choice for beneficiary assignments. The providers can either stick with the current retroactive assignment process or know which patients they will be accountable for ahead of time. Physicians will be allowed to change their assignment process each year.
That's the biggest opportunity for ACOs, according to Clif Gaus, president and CEO of the association.
"The proposed program flexibility would provide ACOs with more choices and let them move to a risk-based model without requiring them to move from retrospective to prospective assignment, as is currently the case with moving to MSSP Track 3 or Track 1+," he said in a comment letter.
ACOs also praised proposals to let them use telehealth services and allow beneficiaries to access skilled nursing facilities without a hospital admission first.
The CMS also suggested allowing ACOs to pay their patients up to $20 for doctor visits or offer other incentives.
But ACOs are still worried about taking on negative financial risks.
Under Obama-era regulations, ACOs that started in Track 1 in either 2012 or 2013 are supposed to move to a risk-based model by the third contract period, which begins next year.
The CMS wants to cut the maximum amount of time ACOs can spend in upside-only risk. If the rule is finalized, first-time ACOs will get two years without financial penalties and they will only receive 25% rather than 50% of their savings. ACOs that participated in MSSP before will only get one year of upside-only risk.
"Our members have expressed concern that limiting upside agreements to two years does not take into account operational challenges in transitioning into an essentially new MSSP program," Dr. Jerry Penso, president and CEO of AMGA said in a comment letter. "We believe CMS should offer a third, upside only year."
ACOs also criticized the CMS for not providing information about performance or benchmark target goals quickly enough. That leaves them "functionally blind" and unable to change course if they're not improving costs or quality, according to Thomas Nickels, executive vice president of the American Hospital Association.
"At a time when ACO participants need to determine how to invest any returns or how to alter their care delivery to achieve savings and improve quality, they have no visibility into whether they even have any returns to invest or whether changes they have already made have produced cost reductions or quality gains," he said in a comment letter.
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