Critic blames CMS for lack of understanding of shared savings accountable care model

Argues plenty of rules, but little detail available to aid financial, risk analysis
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The Centers for Medicare & Medicaid Services is to blame for the lack of research and understanding into how Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) work, a healthcare policy consultant argues in The Health Care Blog.

MSSP ACOs account for two-thirds of all ACOs, but CMS "has made it inexplicably difficult for providers and policy analysts to understand how the MSSP model works operationally," David Introcaso writes. Despite hundreds of pages of existing rules and more to come, CMS has yet to provide any examples relating to recomputing an ACO's financial benchmarks, he says.

"Since there are no examples it's impossible for providers to model with any confidence what these changes would mean to them," Introcaso argues.

In addition, he also says it appears CMS is not conducting any ongoing evaluation of the MSSP ACO, and has only provided general savings, losses and quality score performance information.That could be why a third of MSSP ACO participants dropped out in December, he says. At this point, he adds, Medicare Advantage appears more appealing.

Seven of the 21 participants in Medicare's new Next Generation ACO model were previously MSSP participants, FierceHealthcare recently reported. Eight were Pioneer ACOs, which involved two-sided risk for penalties and bonuses.