Proposed changes to the federal accountable care organization (ACO) model—namely, a cut in the shared savings rate from 50% to 25%—would cut the knees out from under the program, board members of the National Association of ACOs said on Thursday.
Speaking with reporters at their annual conference in Washington, D.C., ACO leaders said they supported many of the proposed changes that the Centers for Medicare & Medicaid Services have brought forward regarding ACOs.
But proposed rules that would speed their path to risk and reduce the reward they would reap in return for any savings they realize are "deal breakers" for new entrants to the program, said Clif Gaus, NAACOS president and CEO.
ACO leaders engage with CMMI’s Adam Boehler in discussion of the program’s future. pic.twitter.com/J5hi1EnWLY— NAACOS (@NAACOSnews) October 4, 2018
"I don’t know any ACO that would roll the dice for 25%," Gaus said. "You’ve got the carrot and the stick. And you just cut the carrot in half."
In August 2017, CMS released a proposed rule (PDF) that would shrink the amount of time ACOs can be in an upside-only model to two years. Currently, 82% of ACOs participating in the Medicare Shared Savings Program (MSSP) are in an upside-only model.
Additionally, those in a Track 1 upside-only model would only be able eligible to take in 25% of any savings. Under the current program, Track 1 ACOs take a 50% cut. In an upside model, ACOs get a portion of any savings generated in treating patients but are still paid by CMS if they incur losses.
Gaus said NAACOS is working to convince both CMS and Congress about the savings the ACO program has reaped, pointing to CMS data as well its own data.
CMS has said MSSP ACOs produced net savings for the Medicare program of $954 million between 2013 and 2015. NAACOS, by contrast, says those same organizations saved $1.84 billion—nearly twice that amount.
Gaus said they are also working to explain why the idea of the shared savings rate of 50% is "non-negotiable" for medical groups to move to ACO models and that cuts would stop the growth of the program in communities across the country.
"Why go to risk if there isn’t a better incentive?" Gaus said.
One thing the ACO's wanted to make clear is they understand the importance of taking on risk, Gaus said.
"We’re viewed as if we don’t like risk. That’s not true. We believe in risk and we believe we should take on risk," Gaus said. "But it’s the path to risk, the speed of the ramp and shifts in savings that makes the difference here. We support the movement to risk, we just don’t believe the proposed pathway is doable."