Medicare will allow shared savings ACOs to participate in CPC+ program

The Centers for Medicare & Medicaid Services (CMS) has decided to tweak its emerging Comprehensive Primary Care Plus program to allow shared savings accountable care organizations (ACOs) to participate.

The decision is a turnaround from when CMS announced the program guidelines back in April, Healthcare Finance News reported. Officials with the agency had said that Medicare would exclude shared savings ACOs due to the rationale that their participation would reduce the motivation to control the cost of the care being delivered.

But, according to Healthcare Finance News, the CMS was heavily lobbied to change the rule, with two former high-ranking Obama administration healthcare officials leading the way: Bob Kocher, a former special assistant to President Obama for healthcare and economic policy, and Farzad Mostashari, former national coordinator for health information technology at the Department of Health and Human Services.

The program will now operate with two payment tracks: Under track one, participating practices will receive a care management fee in addition to their fee-for-service payments. In track two, practices within ACOs will also receive a care management fee, but it will have to be accounted for in calculations for shared savings or shared losses.

The financial issues surrounding the operation of ACOs over the long-term have been complicated. Many ACOs, shared savings model or not, have been reporting losses, with some providers deciding to drop out of the program altogether. Earlier this year, it was reported that only about a quarter of ACOs earned performance bonuses for their work in 2015.

Last month, a survey released by the The National Association of Accountable Care Organizations of its members strongly suggested that many ACO operators would drop out of the program if CMS did not expand the opportunities to participate in alternative payment models.

To learn more:
- read the Healthcare Finance News article

Suggested Articles

Humana has filed suit against the Trump administration over cost-sharing reduction payments.

The Trump administration has launched a new alternative payment model to provide upfront investments to rural healthcare providers.

Nurx raised an additional $22.5 million in funding in May. Find out why CEO Varsha Rao believes telehealth will not go back to pre-COVID-19 levels.