CMS considers compelling acceptance of risk in the voluntary Medicare Shared Savings Program.
National Association of ACOs (NAACOS) released results from a survey of 82 participating ACOs about assuming risk and future participation plans for Medicare Shared Savings Program (MSSP) Track 1 ACOs. Answers to a key survey question show that 71 percent of ACO respondents indicated they are likely to leave the MSSP as a result of having to assume risk.
The NAACOS press release tells us: ACOs have a number of valid reasons for not being ready to assume risk. The survey asked ACOs what they view as their top challenges/barriers to assuming risk. Almost 40 percent of respondents selected the following answers as the top challenges:
- The amount of risk is too great (39.4 percent)
- Concerns about unpredictable changes to the ACO model/CMS rules (39.4 percent)
- Desire for more reliable financial projections (39.4 percent)
Clif Gaus, President and CEO of NAACOS, comments on the survey results,
These results paint a bleak future of what will happen if the government keeps its mandate to push ACOs into risk. It’s naïve to think ACOs that aren’t ready will be forced into risk in what is ultimately a voluntary program. The more likely outcome will be that many ACOs quit the program, divest their care coordination resources and return to payment models that emphasize volume over value. This would be a real setback for Medicare payment reform efforts.
Ann Morse Abdella was committed to the idea when the MSSP started in 2012. She helped startup a rural ACO in western New York, serving about 7,000 Medicare beneficiaries.
Six years later, Chautauqua Region Associated Medical Partners will stop participation..
Abdella describes a constantly evolving program and increasing pressure to take on financial risk are too much to swallow, especially since the region, with a high concentration of managed care, is already fairly efficient in terms of healthcare spending. The prospect of being held responsible for missed savings goals is unsettling since it’s unclear how much fat there is in the system.
Modern Healthcare quotes Abdella, the ACO’s executive director:
We have been trimming and honing and looking at efficiencies and cost savings for a number of years. If we do anything more, we’re going to be anorexic; we’ll kill ourselves.
According to Becker’s Hospital Review, The majority of ACOs are in upside-only risk contracts, they are not financially accountable if they fail to meet financial and clinical benchmarks. This year, 460 of 561 Medicare Shared Savings Program ACOs — CMS’ most popular alternative payment model — remain in Track 1, which is upside-only risk.
In comments to the American Hospital Association meeting, CMS Administrator Seema Verma said:
These ACOs are actually increasing Medicare spending, and the presence of these ‘upside-only’ tracks may be encouraging consolidation in the marketplace, reducing competition and choice for our beneficiaries.
Time will tell which view prevails.