The Centers for Medicare & Medicaid Services today issued a rule finalizing changes to the Medicare Shared Savings Program, including to the structure of payments made to accountable care organizations and other aspects of participation in the MSSP. The changes build on MSSP policies CMS finalized earlier this year in the calendar year 2019 physician fee schedule final rule.
The final rule includes policies to:

  • Redesign the MSSP to include only two tracks – Basic and Enhanced.
  • Move ACOs to two-sided risk more quickly by allowing a maximum of two or three years of participation in upside-only risk.
  • Reduce shared savings rates for upside-only models from 50 to 40 percent.
  • Differentiate between “low-” and “high-revenue” ACOs and require high-revenue ACOs to take on more risk more quickly.
  • Increase the length of agreement periods to at least five years.
  • Allow all ACOs to elect prospective beneficiary assignment or preliminary prospective assignment with retrospective reconciliation.
  • Expand the use of regional factors in the benchmarking methodology.
  • Allow ACOs’ risk scores to decrease by an unlimited amount, without the proposed 3 percent cap.
  • Increase access to waivers of telehealth and other Medicare payment requirements. 

“Today’s final rule will not be helpful in the move toward value-based care,” said Tom Nickels, AHA executive vice president of government relations and public policy. “None of the actions taken today will better empower ACOs to maximize their contribution to patient care and are not pathways for improving the value of the program for patients. We remain opposed to CMS drastically shortening the length of time in which ACOs can participate in an upside-only model. Hospitals and health systems have asked for a more gradual pathway because building a successful ACO that is able to take on financial risk requires significant investments in time, effort and finances.”
CMS also released the financial and quality results for the second performance year of the Next Generation ACO Model, which requires participants to assume the highest level of risk out of all CMS ACO programs in exchange for greater regulatory flexibility. The results show more than $164 million in net savings to the Medicare Trust Funds from the model in 2017 across 44 ACOs, with strong performance on quality metrics.

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