The accountable care organization (ACO) model faces a pivotal moment, and its success or failure depends on what the federal government does next, argues a new white paper from the National Association of ACOs (NAACOS).
The whitepaper, "ACOs at the Crossroads: Cost, Risk and MACRA," states that current options for average ACOs that want to take on further risk are far too drastic, because they require participating physicians to put their entire Medicare income on the line in just the first year of the lowest risk (two-sided) track. Care coordination and information technology, too, represent major financial risk for ACOs, which may help explain the relatively slow growth within the two-sided, higher-risk ACOs compared to their exclusively shared-savings counterparts.
Meanwhile, the Medicare Access and CHIP Reauthorization Act (MACRA) compounds the problem by excluding the lower-risk ACOs from the Centers for Medicare & Medicaid Services' approved list of alternative payment models, according to the whitepaper. More than half of ACOs have said they will leave the program if this proposal is implemented, FierceHealthFinance previously reported.
"ACOs are extremely concerned about the direction the CMS is going not only in the proposed MACRA rules but also with the conflicts created by its other value-based payment programs such as bundled payment," NAACOS President and CEO Clif Gaus said in a statement. "And when you add that to how much it costs to run an ACO, there's a significant number of ACOs ready to leave the [Medicare Shared Savings Program]."
Moving forward, NAACOS urged the federal government to factor ACOs' investments when calculating their risk, as well as addressing flaws in the two-sided risk model that lead to potentially unsustainable risk levels. Moreover, the federal government must make sure all ACOs are covered under MACRA's payment models umbrella, the white paper states.