Providers call for another chance to sign up for Direct Contracting model

Several provider groups are pressing the Biden administration to create another chance for providers to sign up for the Direct Contracting payment model.

Groups complained to the Centers for Medicare & Medicaid Services (CMS) that there will not be a second application period to start to sign up for the model on Jan. 1, 2022, after CMS had previously announced there would be one. The model aims to provide both capitated and partially capitated payments to providers that move away from traditional Medicare fee-for-service.

“We regard this unfortunate decision as a serious blow to the progress of the movement toward value-based care,” according to a letter led by (PDF) America’s Physician Groups and signed by more than 40 groups and stakeholders to the Center for Medicare and Medicaid Innovation (CMMI).

CMMI announced last week that there will be 53 entities that will participate in the first performance year of Direct Contracting, which started on April 1. That is a slight increase of the 51 entities that were in the implementation period that did not require providers to take on financial risk.

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However, CMMI also announced there will not be a second application period for entities to sign up for a Jan. 1, 2022, start date.

“Potential participants have made substantial investments and conducted significant preparation in attempting to meet the requirements of participation for a January 2022 start date,” the letter said.

CMMI ending the application process early is a “great setback in the viability of the model,” the groups added.

CMS told Fierce Healthcare that the reason it is not accepting another round of applications because "it is reviewing its portfolio of model tests and learning from the implementation of this model to inform next steps on [direct contracting]."

The Biden administration has delayed or pulled several models that have yet to start. Chief among them is the Geographic Direct Contracting model that aims to tie capitated payments to providers based on the health outcomes of an entire region.

The National Association of Accountable Care Organizations (NAACOS) was also worried about the future of the Next Generation ACO model, which calls on providers to take on a greater degree of financial risk than ACOs in the Medicare Shared Services Program (MSSP).

The model was originally supposed to expire in 2021, but CMMI extended the model through the end of this year. CMMI has not announced whether it will make Next Gen permanent.

Because of the decision to end a second application period, the ACOs in Next Gen will not have the ability to participate in a higher-risk model and instead must go into the MSSP.

“Next Generation ACOs need clarification on what happens to their participation in high-risk, accountable care models,” said Clif Gaus, president and CEO of NAACOS, in a statement last week.