In a new proposed rule, the Medicare Shared Savings Program redesigns the participation options for the majority of accountable care organizations (ACOs) to encourage a speedier transition to risk bearing tracks, currently Track 1 participants bear no risk and may remain on the track for six years.
The Trump Administration has rebranded the MSSP program as “Pathways to Success” a program that serves 10.5 million Medicare beneficiaries. CMS proposed the rule on Thursday, August 9, 2018.
More than 80 percent of ACOs participate in Track 1 – a shared savings only track (upside-only) and according to the agency, participants in Track 1 “have actually increased Medicare spending relative to their benchmarks.”
CMS also posits that Track 1, “may be encouraging consolidation in the marketplace and reducing competition and choice for Medicare fee-for-service beneficiaries.” In the proposed rule the agency said it believes,
The long term success and sustainability of the Shared Savings Program is affected by a combination of key program factors: the savings and losses potential of the program established through the design of the program’s tracks; the methodology for setting and resetting the benchmark, which is the basis for determining shared savings and shared losses; the length of the agreement period, which determines the amount of time an ACO remains under a financial model; and the frequency of benchmark rebasing.
Under the proposal, current Track 1, Track 1+ and Track 2 would end and ACOs could participate in one of two tracks – Basic and Enhanced – participants in the Basic model can choose from varying levels of risk – the lowest level is one-sided and participants are limited to two years. Track 3 is rebranded as the Enhanced Track. ACOs in the Basic track could steadily phase in higher levels of risk (five levels) and the highest level would qualify as an Advanced Alternative Payment Model (AAPM) under the Quality Payment Program.Those participating in the Enhanced model agree to participate for at least five years, up from three years under current rules, but would qualify as an AAPM right away. Other changes include providing CMS the option of terminating ACOs with repeated years of poor financial performance and holding ACOs responsible for losses even if they leave the program during the performance year.
The American Hospital Association (AHA) said the proposed rule would create barriers to hospitals, health systems and other providers who want to transition to value-based care. Tom Nickels, executive VP for AHA, said drastically shortening the length of time in which ACOs can participate in an upside-only model ignores the reality that providers are starting at vastly different points and will have vastly different learning curves when moving toward value-based care. He added in a statement,
The proposed rule fails to account for the fact that building a successful ACO, let alone one that is able to take on financial risk, is no small task; it requires significant investments of time, effort and finances. Hospitals and health systems must build upon their current infrastructure, which entails forming new and different contractual relationships and incentivizes successful strategies. While some have already taken significant steps toward achieving such alignment, others are not as far down this path. A more gradual pathway is critical for hospitals and health systems that are interested in participating in risk-bearing models – particularly those that are exploring such models for the first time.
CMS said the proposed rule’s policies are designed to increase savings for the Medicare Trust Funds and mitigate losses, reduce gaming opportunities, and promote regulatory flexibility and free-market principles. It would provide new tools to support coordination of care across settings and strengthen beneficiary engagement; ensure rigorous benchmarking; promote EHR interoperability among ACO providers/suppliers; and improve information sharing on opioid use to combat opioid addiction. Finally, the rule addresses new requirements for ACOs as a result of the Bipartisan Budget Act of 2018.
CMS expects the changes will save Medicare $2.2 billion in the next decade.
CMS is taking comments on the proposed rule through October 16, 2018.
Read the proposed rule here
Read 7 things to know about the proposed rule from Becker’s Hospital Review
Health Data Management also has a good recap of the CMS proposal