CMS Final Rule Offers ACOs More Flexibility, Delays Penalties
CMS on Thursday issued a final rule for the Medicare Shared Savings Program that seeks to keep accountable care organization participants in the program by giving them more flexibility, Modern Healthcare reports (Herman, Modern Healthcare, 6/4).
Under existing MSSP rules -- which were adopted in 2011 -- ACOs face penalties after the first three years in the program unless they volunteer to take on downside financial risk earlier in exchange for larger potential bonuses for meeting the program's goals. CMS in December 2014 released a proposed rule aiming to discourage participants from dropping out of MSSP. There are more than 400 ACOs in the program (California Healthline, 12/2/14).
CMS received 275 stakeholder comments about the proposal.
Final Rule Details
Under the final rule, MSSP will offer an additional three years before imposing penalties and a new track in which ACOs can assume more financial risk of patient care (Modern Healthcare, 6/4).
The new track for ACOs will allow them to retain up to 75% of what they save but also be responsible for up to 75% of their losses (California Healthline, 12/2/14). ACOs in the new track also will be given a fixed set of beneficiaries for which they must provide care (Modern Healthcare, 6/4).
The rule also waives the three-day stay period for payments made to skilled nursing facilities for those whose care is provided in the new track (Young, CQ HealthBeat, 6/4).
Meanwhile, ACOs that enter the extra three-year period to avoid financial penalties must be "in good standing with the program" and maintain high quality scores (Modern Healthcare, 6/4).
According to CQ HealthBeat, the new rule also aims to improve data sharing between CMS and the providers participating in ACOs (CQ HealthBeat, 6/4).
CMS said that it expects the rule change will help ensure that 90% of MSSP ACOs stay with the program.
CMS CMO Patrick Conway said, "There's a reality that shifting from fee-for-service to accountable-care models takes time." He added, "That is a long-term transition and can certainly take more than three years," noting that CMS is "trying to meet providers where they are" (Modern Healthcare, 6/4).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.