Accountable care organizations (ACOs) are seeking answers from the Trump administration over the status of the Next Generation ACO Model set to expire this year and the upcoming Direct Contracting Model.
The National Association of ACOs (NAACOS) sent a letter Tuesday to the Center for Medicare & Medicaid Innovation, which oversees the payment models, on the status of both models. The association said value-based care will be even more important during and after the COVID-19 pandemic.
“We need to grow accountable care models to support population health management and give providers the support they need, rather than leaving them uncertain about their future,” the letter from NAACOS President and CEO Clif Gaus said.
The concern centers on payment models that traditionally call for ACOs to take on more financial risk than the Medicare Shared Savings Program (MSSP). An ACO traditionally agrees to take on some level of financial risk for not meeting spending targets and must repay Medicare for not meeting those targets, but it gets a share of any savings.
The Next Gen model—which calls for ACOs to take on more risk than the MSSP—is expected to sunset at the end of the year. CMS has yet to publicly acknowledge whether the model will be renewed.
Some Next Gen participants have said that the agency has told them the model would be scrapped in 2021.
Another concern is a lack of details on the Direct Contracting Model set to go online in 2021. The model includes three voluntary payment models, each offering a different level of risk-sharing.
The Centers for Medicare & Medicaid Services (CMS) has yet to divulge key details including risk adjustment and benchmarking, which will help ACOs set their Medicare spending targets.
“The application period for the first performance year of the Direct Contracting model recently came and went without the application portal being opened,” the letter said.
NAACOS wants the Next Gen model to be extended for at least another year and give clarity on Direct Contracting “as soon as possible so that providers have time to formulate their participation plans for the upcoming year.
Complicating the issue for ACOs when deciding on a payment model is that there will not be an application period in 2021 for the MSSP.
CMS canceled the application period to give ACOs with participation set to end in 2021 an option to just extend for another year and reduce administrative burden during the COVID-19 pandemic.
However, the cancellation of the application year could leave Next Gen ACOs and ACOs thinking of joining Direct Contracting in an awkward spot.
“With no 2021 application period for the MSSP, our members are increasingly frustrated that they will not have time to evaluate their participation options for the upcoming year,” the letter said.
NAACOS also asked CMS to give Next Gen ACOs the option to be protected from losses in 2020 in exchange for a reduced shared savings rate of no less than 40%. CMS also needs to pay Next Gen ACOs and any advanced alternative payment model bonuses quickly, as the payments are typically distributed in late summer or early fall, the letter said.
CMS has given some regulatory relief for ACOs and other value-based care programs, including mitigating any losses for the duration of the COVID-19 public health emergency.
A CMS spokesperson told FierceHealthcare the agency remains committed to moving toward value-based care.
“We are conscious of the impact that COVID-19 is having on our model participants, healthcare providers and the economy in general, and we continue to look closely at all of our models to see where we can take steps to address the unique nature of COVID-19,” the spokesperson said.