Providers want CMS to waive penalties, extend deadlines for alternative payment models due to coronavirus

care coordination
Provider groups such as the American Hospital Association and the National Association of ACOs want Congress and the Centers for Medicare & Medicaid Services to give flexibility to provider organizations in alternative payment models. (Getty)

A collection of provider organizations is asking Congress and the Trump administration to waive any penalties or quality performance scores for 2020 for accountable care organizations (ACOs) and other providers in alternative payment models (APMs) battling the coronavirus outbreak.

The letter, led by the National Association of ACOs, calls for Congress and the Centers for Medicare & Medicaid Services (CMS) to help ensure the virus doesn’t sink facilities and physicians in APMs including the Merit-based Incentive Payment System (MIPS) and the Medicare Shared Savings Program (MSSP).

The concerns come as the number of coronavirus cases continues to surge past 7,000. 

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“In the immediate term, [alternative payment model] participants will be faced with difficult decisions about whether they can continue to afford to provide advanced preventative care, care coordination, and behavioral services, hallmarks of these models,” the letter to CMS said.

The problem for providers in APMs is they will be hit twice by the coronavirus: first at the onset of the outbreak and again when “spending is evaluated at the year end in the context of their value-based performance,” the letter said.

An APM takes on varying levels of downside financial risk, where they must not go over spending targets. Any overages they have to pay back to Medicare, and they get a share of any savings.

The American Hospital Association, the American Academy of Family Physicians, the American Medical Group Association, America's Essential Hospitals, the Association of American Medical Colleges, the Federation of American Hospitals, the Health Care Transformation Task Force and the Medical Group Management Association also signed on to the letters.

Providers to CMS: Change the deadlines

The letter from ACOs and physician groups calls for CMS to extend upcoming deadlines for ACOs as a surge of coronavirus cases is looming.

Among the deadlines the groups want to change are:

  • The March 31 deadline for MIPS and MSSP to report 2019 data to at least June 30;
  • The submission deadline for MSSP and MIPS measure submissions for the 2021 performance year to July 1;
  • Application timelines for joining alternative payment models including the direct contracting application cycle for the 2022 performance year;
  • Open the Primary Care First 2022 application cycle to physicians that aren’t in the Comprehensive Primary Care Plus model.

Hospital and clinician finances are also going to be strained by the cancellation of elective procedures and routine appointments.

Some value-based care programs do have a policy in place to mitigate losses from “extreme and uncontrollable circumstances.” But the letter said these policies vary widely across programs.

MSSP, for example, only mitigates shared losses and adjusts quality assessments based on the ACO patient population that is affected by the disaster, the letter added.

However, the policy doesn’t address the savings the ACO would have received without the strain from the coronavirus.

So the groups urge Congress and CMS to “hold clinicians harmless for performance-related penalties for the 2020 performance year, particularly those in two-sided risk APMs.”

They also want CMS to hold clinicians and ACOs harmless from any quality assessments for 2020.

The groups added that CMS should consider additional options for helping APM participants whose financial resources are going to be wiped out after the outbreak.

This support would include reinsurance or upfront funding where CMS offers financial help to new ACOs to handle upfront costs with setting up and managing an ACO.

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