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Could the Medicare ACO Program Be in Deep Trouble? Check Out the Latest Survey

November 13, 2014
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If the results of a newly released survey from the National Association of ACOs are any indication, the Medicare Shared Savings Program for ACOs is in very deep trouble

If the results of a newly released survey from a national association are any indication, the Centers for Medicare and Medicaid Services (CMS) is in serious, serious trouble around accountable care. That’s because the results of the survey sponsored by the National Association of ACOs (NAACOS) are truly ominous for the development of accountable care organizations under CMS’s Medicare Shared Savings Program (MSSP) for ACOs.

According to its Nov. 3 press release, “NAACOS continues to track the plans of ACOs to stay in the Medicare Shared Savings Program, and results from the October 2014 survey show that two out of three MSSP ACOs are highly unlikely or somewhat unlikely to remain in the ACO Program. This is exactly the same as in our April 2014 survey, but the additional category of ‘undecided’ was added,” the press release notes. “This resulted in almost all of the ACOs that said in April that they were likely to sign a contract moving to the undecided category. As a result, only 8 percent of ACOs are likely to sign a second contract, and 92 percent either unlikely or undecided.” The press release quoted Clif Gaus, president of NAACOs, who stated that “This continues to be the most troubling aspect of the Medicare Shared Savings Program, and must be sufficiently addressed in the upcomimg CMS proposed rules, or the MSSP will no longer exist, and the high hopes of DC policymakers to migrate ACOs to two-sided risk will be impossible.”

That 8-percent survey result can only be seen as devastating for CMS officials. The simple reality is that if a majority of those organizations participating in the MSSP leave en masse, it will cripple the program, at a time when CMS needs more signs of success, both in the MSSP and in the Pioneer Program, which has suffered notable withdrawals this year.

The NAACOS press release also included this: “On October 31, CMS finalized changes to the Medicare Shared Savings Program (MSSP) quality measures and benchmarks. While the National Association of ACOs is pleased CMS responded to several ACO provider concerns, we believe that changing 25 percent of the measures is too disruptive and costly for the ACOs and do little to better inform the consumer. NAACOs will continue to recommend fewer and more outcomes-based measures. Further,” the press release said, “while CMS will modestly take into account year-over-year increases in each quality measure, the quality measurement system in total will exclusively reduce the savings earned by the ACOs and provide no positive reward for improving the quality of healthcare to Medicare beneficiaries.”

In short, the results of the NAACOS survey show what many of us already knew—that the MSSP program is truly at a crossroads right now, caught between a proverbial Scylla and Charybdis of choices for every stakeholder in this accountable care landscape. It’s understandable that CMS officials would want the MSSP program (and of course, the Pioneer program, even more so, for that matter) to be as rigorous as possible and to show the most robust, advancing outcomes possible. On the other hand, even the level of rigor in the one-sided risk program right now, coupled with the high levels of outcomes demanded by CMS, is making this a very difficult row to hoe for the ACOs involved in the MSSP.

So at some point, CMS officials seriously risk torpedoing their entire program, unless they can somehow make the kinds of concessions—or at least some of the concessions—being asked for by participants. Certainly there must be common ground here somewhere. What’s more, both “sides” are learning a lot—and will continue to do so going forward.

But it’s clear, given the results of this latest survey of MSSP participant organizations, that, as the popular saying goes, “Something’s gotta give.”

And one would hope that CMS officials would be able to move forward with alacrity to create stronger bridges of understanding, in order to preserve the MSSP program—not to mention the Pioneer program—because the learnings taking place in both programs really do have the potential to transform healthcare as we know it, and we desperately need the success that can come out of both programs, to help point the way forward into the new healthcare. So does a survey matter? Yes, definitely. And in this case, more than most.