ACOs Want Later Dropout Date for Medicare Shared Savings Program

Accountable care organizations (ACOs) are calling for more support during the coronavirus pandemic, including more time to decide whether to continue participation in the Medicare Shared Savings Program (MSSP) as financial losses grow due to COVID-19.

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Participants of Medicare’s flagship ACO program currently have until June 1, 2020, to voluntarily exit the program without financial penalty. However, in light of the coronavirus pandemic, the deadline should be moved to no earlier than October 31, 2020, the National Association of ACOs (NAACOS), American Medical Association (AMA), and several other groups said in a recent letter to CMS Administrator Seema Verma.

"Given a potential resurgence of the virus this fall, it is imperative for CMS to provide ACOs with additional time and data to make an informed decision about their ACO participation,” the groups wrote in the letter.

At a minimum, CMS should give ACOs 90 days from the start date of the second interim final rules with comment period (IFC) to give participating providers enough time to consider program adjustments recently released by the federal agency, they added.

The second IFC, CMS-5531-IFC, Medicare and Medicaid Programs, Basic Health Program, and Exchanges; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program, was published on the Federal Register May 8.

Together with an April 6 IFC (CMS-1744-IFC, Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency), the rule enacted the MSSP extreme and uncontrollable circumstances policy and other program adjustments, including removing expenditures for months that include COVID-19 episodes triggered by an inpatient coronavirus diagnosis and allowing ACOs to remain in their current risk level for the 2021 performance period.

But additional efforts are needed to support ACOs and subsequently the transition to value-based care, the nine industry groups stressed.

“CMS must act now to retain physicians and hospitals who have committed to accountable care and the transition to value, especially those that have assumed high levels of risk,” they wrote in the letter.

To ensure future participation in the MSSP, the groups also advocated for:

• A policy to give ACOs an option to be protected from losses in exchange for a reduced shared savings rate of no less than 40 percent
• Reversal of the decision to cancel the 2021 MSSP application cycle as detailed in the May 8 IRC
• The payment of ACO shared savings payments and Advanced Alternative Payment Model (APM) bonuses as soon as possible

“Implementing the recommendations above will help ensure the future of ACOs and value-based care overall,” the groups wrote in the letter.

ACOs are uniquely positioned in the coronavirus crisis, NAACOS emphasized. The ACO model’s focus on care coordination and building an infrastructure for coordinated population health management has been key to combating the deadly virus, the association stated.

A recent survey of 20 ACOs led by researchers with Hamilton College and Within Health found that the organizations are leveraging telehealth, artificial intelligence, and other automation solutions to provide critical COVID-19 care, including identifying and reaching out to high-risk patients and coordinating with specialists.

However, the surveyed ACOs confirmed what NAACOS and others have been saying since the start of the pandemic: ACOs are struggling to control costs and as a result, are rethinking their participation in the MSSP.

About a quarter of ACOs in the survey reported exiting the financial risk model altogether and moving back towards Medicare fee-for-service because they are unsure of hitting their benchmarks. Additionally, all of the ACOs expressed concerns about shared losses not just in 2020, but also in 2021.

Providing ACOs with more flexibilities during the pandemic will be key to keeping the organizations running to combat COVID-19, NAACOS and the eight other industry groups stated.