Stakeholders Say ACO Final Rule Fails To Address Some Concerns

Some health care organizations might opt to leave the accountable care organization program because CMS did not address some of their concerns in its latest rules update, Modern Healthcare reports (Dickson, Modern Healthcare, 6/5).

New Final Rule Details

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.

Under previous MSSP rules -- which were adopted in 2011 -- ACOs faced penalties after the first three years in the program unless they volunteered 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.

Under the new 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. 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. ACOs in the new track also will be given a fixed set of beneficiaries for which they must provide care (California Healthline, 6/5).

CMS has estimated that allowing additional time in the lower-risk track will encourage as many as 90% of participants to continue in the program, according to Modern Healthcare.

Of 400 ACOs, about 230 have finished three-year commitments and are making their decisions about whether to continue, according to Jeffrey Spight, who serves on the National Association of ACOs board and is president of Collaborative Health Systems (Modern Healthcare, 6/5).

Stakeholder Reaction

Medical groups support CMS' move to meet providers' calls to accept some financial risk in order to continue participating in the program. However, they also said that CMS did not do enough to address other concerns (Young, CQ HealthBeat, 6/5).

Some stakeholders have said the final rule permits waivers for ACOs in riskier tracks that are not offered to ACOs that choose not to risk penalties for missing meeting quality and cost benchmarks.

In addition, some ACOs might be discouraged that the government has not revamped the measures that determine ACO's success in holding down costs. Several have said the policy penalizes providers that are efficient (Modern Healthcare, 6/5). CMS plans to issue a benchmark rebasing methodology in a rule coming later in the summer.

Some medical groups also said they would like a policy that assigns beneficiaries to ACOs voluntarily.

National Association of ACOs CEO Clif Gaus said that additional revisions could have made it more appealing for medical offices to move to Track 2 and 3 of the program.

CMS said in the final rule that it is still considering further changes to the ACO program (CQ HealthBeat, 6/5).