On Thursday, April 30, the federal Centers for Medicare & Medicaid Services (CMS) made a wide range of changes to Medicare program policy in a variety of areas, including COVID-19 testing, flexibility around site of service and which clinicians can provide which services, and around participation in the MSSP Program for ACOs (accountable care organizations). And the agency’s policy changes in the ACO area elicited immediate praise from the Washington, D.C.-based NAACOS (National Association of ACOs), and the Charlotte-based Premier Inc.
The portion of CMS’s broad announcement Thursday read thus: “In addition, CMS is making changes to the Medicare Shared Savings Program to give the 517 accountable care organizations (ACOs) serving more than 11 million beneficiaries greater financial stability and predictability during the COVID-19 pandemic…. Because the impact of the pandemic varies across the country, CMS is making adjustments to the financial methodology to account for COVID-19 costs so that ACOs will be treated equitably regardless of the extent to which their patient populations are affected by the pandemic. CMS is also forgoing the annual application cycle for 2021 and giving ACOs whose participation is set to end this year the option to extend for another year. ACOs that are required to increase their financial risk over the course of their current agreement period in the program will have the option to maintain their current risk level for next year, instead of being advanced automatically to the next risk level.”
On that same day, NAACOS issued a statement attributed to its president and CEO, Clif Gaus, Sc.D., in which the association said that “NAACOS thanks CMS Administrator Seema Verma and her staff for their hard work to address the COVID-19 pandemic’s effect on ACOs and for listening to our concerns. CMS addressed many of the issues NAACOS raised in March when this pandemic first hit hard, and the rule is a fair way to handle ACO performance during a global public health pandemic. We’re appreciative of the thoughtful ways CMS will modify the Shared Savings Program during the public health emergency, especially by removing spending associated with COVID-19 patients from performance calculations. NAACOS and others asked for this change last month. CMS’s extending its mitigation of shared losses back to January 2020 and providing flexibility for ACOs to stay in their same risk track next year will help sustain participation in the program for 2020.” Yet even while thanking Verma for that move, NAACOS stated that “[W]e were disappointed to see there will be no application period in 2021 for new ACOs and hope CMS will be open to a partial 2021 performance year as the healthcare industry stabilizes. NAACOS remains concerned about the uncertainty of the length of the public health emergency and believes COVID-related costs should be removed from the entire performance year.”
And Premier Inc. released a statement attributed to Blair Childs, the organization’s senior vice president, public affairs, in which it stated that “Premier appreciates the Centers for Medicare & Medicaid Services’ release of additional details on how it will mitigate COVID-19 impact on Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) and doing so in advance of the deadline for ACOs to leave the program without financial penalty. Giving ACOs the option to maintain their current level of risk for an additional year and to extend expiring agreements is critical. This will help providers remain focused on their public health emergency response while maintaining their investments in population health. These actions align with Premier’s previous requests to the Administration, Congress and the Medicare Payment Advisory Commission aimed at maintaining the movement to value-based care.”
But both groups had criticisms of CMS as well. Premier’s Childs stated that “We are, however, disappointed that new entities are unable to enter the program until January 2022. As this public health emergency has variable impacts across the country, some entities are ready and willing to enter the program. They should have that opportunity. Additionally, CMS must ensure alignment across Innovation Center programs by allowing a one-year extension for all models. Moreover,” he said in the statement, “we appreciate that, as a risk mitigation step, CMS removed COVID-19 episodes triggered by an inpatient admission from the calculation of ACO expenditures. However, it is unclear if this policy will be sufficient to mitigate exposure to losses. The regional variability in testing and changes in coding and documentation guidance may result in undercounting COVID-19 expense. We applaud CMS for considering additional approaches to mitigate the financial impact beyond the current extreme and uncontrollable circumstances policy.”
In fact, Child’s statement continued, “In the absence of knowing when the public health emergency will conclude some ACOs may be uncomfortable with remaining in a risk-based arrangement. CMS must send a signal that down-side risk entities are valued. This can be done by providing a one-time incentive to two-sided risk ACO entities and a MACRA bonuses to all clinicians in those ACOs. We look forward to continuing to work with CMS in this regard.”
And NAACOS’s Gaus stated that, “We are, however, disappointed that new entities are unable to enter the program until January 2022. As this public health emergency has variable impacts across the country, some entities are ready and willing to enter the program. They should have that opportunity. Additionally, CMS must ensure alignment across Innovation Center programs by allowing a one-year extension for all models.”
