Lawmakers ask CMS to reconsider ACO MSSP overhaul
ACOs in upside-only models need more than two years and shared savings rate put forward by CMS, lawmakers, stakeholders say.
Nine bipartisan lawmakers have added their voices to concerns from provider groups over proposed reforms to the Medicare Shared Savings Program.
The U.S. House of Representatives members want to see two key changes to the proposed rule, and their concerns mirror those expressed by healthcare industry associations in a similar letter sent to the Centers for Medicare and Medicaid Services last month.
They want CMS to reconsider cutting the time new accountable care organizations can stay in upside-only shared savings models from six years, to two, and to stop the cut to the shared savings rate from 50 percent to as low as 25 percent.
The lawmakers sent the letter Wednesday to CMS Administrator Seema Verma.
WHY THIS MATTERS
An estimated 472 accountable care organizations take part in MSSP, an accountable care organization program designed to move providers forward in value-based care.
CMS estimates that ACOs participating in 2017 generated gross savings of $1.1 billion and net savings of $314 billion, according to the letter.
But in the proposed overhaul of the program released in August, CMS Administrator Seema Verma said the ACO program has not lived up to the accountability part of its name. The majority of ACOs are not taking on risk, she said.
Under the proposed rule updating the program, Medicare would save an estimated $2.2 billion over 10 years.
Over 100 ACOs would be expected to drop out of MSSP, according to CMS estimates.
THE TREND
Conveners in a risk program that began October 1, the Bundled Payments for Care Improvement Advanced, say there's been a huge surge of interest in the model, partly because it qualifies as an advance alternative payment model under MACRA and its 5 percent bonus payment.
CMS touts the ACO model of Next Generation, which takes on the most risk, as the direction it wants to see for provider organizations.
Next Gen also qualifies as an APM.
ON THE RECORD
"As we move forward in implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), it is imperative that MSSP ACO participants remain a workable option because MACRA's fundamental structure is premised on the ability to participate under an Advanced Alternative Payment Model track, which primarily includes ACO models," the lawmakers said.
Representatives who signed the letter include Diane Black of Tennessee, Peter Welch of Vermont, Suzan Delbene of Washington, Gene Green of Texas, David Roe, of Tennessee, Greg Gianforte of Montana, Tom Reed of New York, Brad Wenstrup of Ohio and Roger Marshall of Kansas.
Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com
