The Centers for Medicare & Medicaid Services late today issued a proposed rule that would redesign the Medicare Shared Savings Program’s participation options by offering eligible accountable care organizations two tracks, which they would agree to participate in for at least five years.

Specifically, a BASIC track would allow eligible ACOs to participate under a one-sided, upside-only agreement for one to two years and then incrementally phase in higher levels of risk. At the highest level of risk, the BASIC track would qualify as an Advanced Alternative Payment Model under the Quality Payment Program. CMS also would offer an ENHANCED track based on the program’s existing Track 3. The changes would apply for agreement periods beginning on July 1, 2019 and in subsequent years. The current Track 1, Track 1+ and Track 2 would be discontinued for future applications. The methodology for determining quality performance would remain mostly consistent with the existing MSSP program, but CMS solicits input on ways to enhance the program’s measure set, including how to address opioid use. CMS also proposes to require ACOs to attest that a certain percentage of clinicians are using certified electronic health record technology.

“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,” said AHA Executive Vice President Tom Nickels in a statement. “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.”

Nickels also said that for hospitals and health systems, and other providers that “want to come together to provide the highest quality care for patients, the proposed rule would create barriers to entry in transitioning to value-based care. We will urge CMS to ensure that it strikes a balance between quality care for Medicare beneficiaries; savings for the Medicare program; and sufficient opportunity for ACOs to invest in the infrastructure necessary to successfully take on risk.”

Comments on the rule are due Oct. 16.