ACOs may have three more years before sharing risk with CMS

December 2, 2014

CMS wants to create additional ACO models to increase both participation and risk and reward opportunities.

Accountable care organizations (ACOs) will have three more years before taking on more financial risks, if a proposed rule from the Centers for Medicare & Medicaid Services (CMS) is adopted.

Under CMS’ proposal, ACOs that are currently participating in Medicare Shared Savings Program (MSSP) one-sided performance risk models can enter another three-year, one-sided program instead of moving into two-sided models where the ACO shares financial risk with CMS. The initial, three-year contracts that ACOs signed to join MSSP in 2012 will be up for renewal in 2015.

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The savings potential of ACOs has been questioned after an initial rocky start to the program. In January, CMS reported that only 29 ACOs earned any savings. Currently, more than 330 ACOs in 47 states are enrolled in MSSP. Of those, 58 are beating their benchmarks and sharing more than $315 million in savings. Sixty ACOs are also performing better than their benchmarks, but not by enough to earn any shared savings.

In May, a survey by the National Association of ACOs found that 46% of ACOs were very unlikely to accept two-sided shared risk models with MSSP in the upcoming contract renewal period. Only a third of ACOs said it was somewhat or very likely that they would accept the MSSP contracts.

CMS wants to create additional ACO models to increase both participation and risk and reward opportunities. Another proposed two-sided risk model that CMS calls “track 3” would assign a list of beneficiaries to each ACO that cannot be changed for the duration of the performance year. CMS also proposed expanded telehealth, flexible post-acute care referrals, and attestation from beneficiaries to help ACOs with care coordination, in the hope that it will lead to more two-sided risk models.

The proposed CMS rule puts greater emphasis on nurse practitioners and physician assistants in primary care and allows specialists to work with multiple ACOs. CMS will accept comments on the proposed rule for 60 days.

“This proposed rule is part of our continued commitment to rewarding value and care coordination – rather than volume and care duplication,” CMS Administrator Marilyn Tavenner said in a press release. “We look forward to partnering with providers and stakeholders to continuously refine and improve the Medicare Shared Savings program.”