A coalition of 20 healthcare organizations--including powerhouses such as the American College of Physicians, the American Medical Association, the Association of American Medical Colleges and the Premier healthcare alliance--has sent a letter to the Centers for Medicare & Medicaid Services, urging changes to the benchmarking methodology for accountable care organizations (ACOs) and the related Medicare Shared Savings Program (MSSP).
Among the changes requested are for the federal agency to:
- Blend regional cost data with ACO historical cost data to set reimbursements (current rates are based on ACO data only)
- Provide ACOs with a choice for transitioning into a system based on regional cost data
- Finalize the optional fourth year in Track 1 for ACOs moving to Track 2 or Track 3
- Provide participants with relevant data to model the impact of adjusting benchmarks
- Replace the national trend factor with a regional trend factor for ACOs in second and subsequent agreement periods
- Consider a different approach to ensure a statistically valid population for calculating regional end stage renal disease costs rather than using state averages
- Honor the current policy accounting for savings in rebased benchmarks
The CMS proposed changes earlier this year to some of the structures of ACOs participating in the Shared Savings Program, including using regional data on which to base some payments.
"Our recommendations reflect our unified expectation and desire to see the Medicare Shared Savings Program achieve the long-term sustainability necessary to enhance care coordination for Medicare beneficiaries, lower the growth rate of healthcare spending and improve quality in the Medicare program," said the letter, addressed to acting CMS Administrator Andrew Slavitt. "Specifically, our key goals for the MSSP include encouraging increased participation, enabling existing ACOs to continue in the program and creating a successful, long-term ACO model for Medicare."
Many providers have already left Medicare's experimental Pioneer ACO program, citing financial difficulties if they were to move forward. The most recent departures included Dartmouth-Hitchcock Medical Center and Beacon Health.
To learn more:
- read the letter