CMS looks to adapt ACO benchmarks to regional realities

The Centers for Medicare and Medicaid Services is proposing changes in the benchmarks it uses to evaluate ACOs in the Medicare Shared Savings Program.

In a fact sheet posted Jan. 28, the agency indicates it wants to segue from its initial focus on ACOs’ respective historical-spending benchmarks to the ACOs’ performance controlling fee-for-service costs within their respective regions during a second or subsequent agreement period.

To make the move, CMS would reset participating ACOs’ benchmarks in such a way as to:

  • Establish each ACO’s “rebased” historical benchmark by replacing the current national trend factor with regional trend factors;
  • Adjust the ACO’s rebased historical benchmark to reflect the difference between the regional fee-for-service costs in the ACO’s regional service area and the ACO’s historical expenditures; and
  • Update, on an annual basis, the rebased benchmark to account for changes in regional fee-for-service spending.

The latter change would replace the current update, which is based solely on the absolute amount of projected growth in national fee-for-service spending.

In a press release promoting the action, Andy Slavitt, the agency’s acting administrator, says the changes would facilitate ACO success by having CMS recognize “both their achievements and improvements in how they provide care.”

“This should have the effect of growing the number of ACOs, and making ACOs and the coordinated care they provide to patients, more of a standard in all parts of the country,” Slavitt adds.

CMS says its Jan. 28 proposal reflects extensive input from stakeholders.

The proposed rule will be open for comment for 60 days.

For more information and related links, click here for the fact sheet and here for the press release.