CMS released a final rule Monday that aims to strengthen incentives for accountable care organizations in the Medicare Shared Savings Program.
Regarding the changes, CMS Acting Administrator Andy Slavitt said they will "encourage more physicians to improve patient care by joining ACOs, while also refining how the program measures success, so that current participants are better rewarded for quality."
Mr. Slavitt said the changes will also help physicians prepare for the new Quality Payment Program, which will hold providers to unprecedented levels of accountability not just for reporting, but also, among large physician groups, for their performance on a broad range of behaviors.
Here are five takeaways from the MSSP ACO final rule.
1. CMS modified the process for resetting benchmarks used to determine ACO performance. When an MSSP ACO enters a second or subsequent agreement period, CMS will use regional, rather than national, spending growth trends to update the ACO's financial targets.
2. CMS removed the adjustment that explicitly accounts for savings generated under an ACO's prior agreement period. This change limits the link between an ACO's performance and its future benchmarks. This will help ensure an ACO's efficiency is measured against providers in the same regional market, rather than just against its own past performance.
3. The rule includes a phased-in approach to implementation. CMS will begin to phase in the new methodology for MSSP ACOs entering contract periods beginning on or after Jan. 1, 2017.
4. CMS finalized an additional option for ACOs participating under Track 1 to apply to renew for a second agreement period under a two-sided model. Under the final rule, if an ACO's renewal request is approved, it has the option of extending its initial agreement under Track 1 for a year before taking on financial risk under Track 2 or Track 3.
5. The rule establishes timeframes and criteria for ACOs to appeal CMS' calculation of bonuses and penalties. Under the final rule, ACOs have four years to challenge an initial determination of shared savings or shared losses for good cause.
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