Perils on the road to Accountable Care Organizations

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Perils on the road to Accountable Care Organizations

August 11, 2015
From the August 2015 issue of HealthCare Business News magazine

HealthCare Business News spoke with Karen Ferguson, senior director of public policy, and Garrett Eberhardt, manager, government relations, from the American Medical Group Association (AMGA). AMGA represents the interests of multispecialty medical groups and other large, integrated health care delivery systems. Of AMGA’s member medical groups, 135 of them have embarked upon the Accountable Care Organization (ACO) journey. HCB News asked Ferguson and Eberhardt for their reactions to the recent Centers for Medicare and Medicaid Services (CMS) final regulations on the Medicare Shared Savings Program (MSSP) and their impact on ACOs.

HCB News: CMS recently published final regulations that made modifications to the MSSP. In general, what impact do you think they will have on medical groups and health care systems as they decide whether to continue participation in the MSSP, or apply to be an ACO for the first time?

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AMGA: CMS made some important programmatic changes in the final rule. We were pleased to see that CMS will permit ACOs to remain in Track 1 for another three-year agreement period at the same minimum savings rate. The original proposal would have levied a financial penalty on Track 1 ACOs that wanted to remain in Track 1 for another agreement period to gain additional experience. CMS also streamlined the process for ACO beneficiaries to opt-out of data sharing.

Instead of the ACO handling the process of providing data opt-out, which had been cumbersome, now the ACO will be required to post a notice at the point of care advising their patients to call Medicare directly to handle the opt-out process. This will remove a lot of administrative burden. While we were pleased with some of the final provisions, we believe the agency could have done more in the final rule to incentivize participation in the MSSP, such as expanding the ability of ACOs in all tracks to apply for waivers from certain Medicare requirements.

HCB News: CMS seems anxious to push MSSP participants toward signing up for a risk-bearing track. Do you think the health care industry as a whole is ready to transition into risk-bearing arrangements?

AMGA: Despite the recent push from CMS and others in the Washington health care policy sphere, most evidence points to health care providers not being ready to assume risk in their operations. Currently, only three ACOs are participating in the risk bearing Track 2 of the MSSP. The uncertainty surrounding integral parts of the program, such as risk-adjustment and beneficiary attribution, and the lack of assurances that these uncertainties will be adequately addressed, have made many providers hesitant to commit to assuming risk in the MSSP.

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