AMA and others ask CMS not to finalize proposed ACO quality changes

Citing the ongoing COVID-19 public health emergency, 10 leading healthcare organizations are urging CMS not to move forward with changes to how accountable care organizations and other alternative payment models are assessed on quality in the Medicare Shared Savings Program and the merit-based incentive payment system.

The proposed changes are in the 2021 proposed physician fee schedule.

CMS proposes to abruptly end the use of the Web Interface reporting mechanism, a tool that has been used since the MSSP's inception, the group said. 

The proposed rule would also remove the pay-for-reporting year currently provided to ACOs beginning an initial MSSP contract, as well as individual measures that are newly introduced to the measure set.

CMS also proposes significant changes to the quality measure set ACOs must report under the new APM Performance Pathway. 

Finally, the proposed rule would replace the current MIPS APM Scoring Standard, which allows each APM to have its own set of unique quality measures and scoring approaches that best fit the particular model.

WHY THIS MATTERS

The changes proposed would alter the way ACOs report and are measured on quality and come at a time when the healthcare industry continues to deal with the uncertainty of the ongoing pandemic, the letter to CMS Administrator Seema Verma said. 

Additionally, the expected delayed release of the final rule further reduces the amount of time ACOs and other APMs would have to implement such changes.

CMS's proposals to change the way ACO quality is assessed, reported and scored for purposes of shared savings calculations are significant and more feedback should be collected before moving forward with such drastic changes, according to the letter signed by the American College of Physicians, American Medical Association, America's Essential Hospitals, America's Physician Groups, AMGA, Association of American Medical Colleges, Federation of American Hospitals, Medical Group Management Association, National Association of ACOs and Premier.

THE LARGER TREND

ACOs must reduce spending and meet certain quality performance standards to be eligible to receive shared savings payments. 

This year, due to CMS not making ACO suggested changes to quality reporting because of the pandemic, accountable care organizations are having difficulty meeting the quality standards, according to the National Association of ACOs.

CMS has been shifting providers and ACOs to take on more risk in advanced alternative payment models. But due to unrealistic increases in required thresholds for earning the Advanced APM bonus, fewer providers are expected to earn the bonus based on 2021 performance as compared to the last two years. 

ON THE RECORD

"Just as CMS has proposed to delay moving forward with the MIPS Value Pathways approach due to concerns with COVID-19, CMS should also postpone such a drastic and significant change to the way ACO quality is measured, assessed, reported and scored for purposes of both the MSSP and MIPS programs," the groups said.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com