Healthcare groups warn of consequences over new ACO rules

Industry groups have submitted their final comments on CMS’ recent proposal to overhaul the Medicare Shared Savings Program (MSSP), warning that some of the new changes could result in fewer accountable care organizations participating in the program.

The proposed rule, which was announced in August, would force ACOs to take on downside financial risk after just two years of participating in the MSSP, down from the current timeline of six years. CMS’ own projections indicated that the change would drive many ACOs out of the program. And HHS Secretary Alex Azar stated that a drop-off of participation in the voluntary program isn’t a big concern for the agency.

However, the American Hospital Association––which represents about 5,000 hospital and health system members, including 270,000 physicians and 2 million nurses and caregivers––is concerned over CMS’ disregard for that outcome.

AHA also disagrees with CMS that the changes will encourage greater shared savings.

“Drastically shortening the length of time in which they can participate in an upside-only model, along with attempting to create arbitrary differentiations between physician- and hospital-led ACOs, does not empower ACOs to maximize their contribution to patient care and is not a pathway for improving the value of the MSSP for beneficiaries,” AHA wrote in its comments.

CMS should instead improve its program methodology to better reward performance and cost savings, the association argued.

Similarly, The American Medical Group Association, which represents more than 450 medical group and integrated delivery systems, objected to CMS’ method of measuring program performance against ACO benchmarks, which are serving as the agency’s justification to rush into risk-bearing ACOs.

“We do not believe there is adequate information to conclude at risk ACOs out-compete no risk ACOs,” AMGA wrote in its comments. “Among other reasons, again, it has been convincingly demonstrated that ACO financial benchmarks are not legitimate counterfactuals.”

The association does support general moves toward risk-bearing agreements, but the limited time period of two years is not enough transition time, it said.

Both associations voiced concerns that the changes could create different participation options for high- and low-revenue ACOs, which could penalize some based on size alone and volume of services.