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Advocacy Groups Give Mixed Reaction to New ACO Rule

December 3, 2014
by Gabriel Perna
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Advocacy groups representing various industry stakeholders are both pleased and perturbed with the Centers for Medicare & Medicaid Services’ (CMS) new Shared Savings Program and Accountable Care Organization (ACO) proposed rule.

CMS released this proposed rule earlier this week. It included the introduction of a new two-sided risk model, being called “Track Three,” which will integrate elements from the Pioneer ACO program, such as higher rates of shared savings and prospective attribution of beneficiaries. “Track Three” includes more risk, but more savings for participants, specifically up to 75 percent savings based on quality performance.

 In exchanging for going with the new two-sided risk model, ACOs will be given a longer lead time to transition including those in one-sided risk in the first agreement period. This proposal has won the support of the American Medical Group Association (AMGA). However, AMGA says ACOs should not be further penalized for deferring risk-taking. Specifically, they are upset that those who elect to stay in one-sided risk track for three additional years will earn less in shared savings by doing so.

According to Donald W. Fisher, Ph.D., president and CEO of AMGA, it “requires significant time to develop the new cultural, clinical, financial, analytic, and administrative competencies needed to manage population health.”

The National Association of ACOs (NAACOS) had a similar reaction. They were pleased with the new sets of benchmarking for the Track Three two-sided risk model but asked CMS to consider changes to one-sided risk benchmarking, specifically, the reduced sharing formula of 40-60 instead of 50-50.

“We commend CMS for extending the one-sided program but the facts are (1) only 25 percent achieved savings so far, (2) in future years over 90 percent of the ACOs that achieve savings will have them reduced substantially by the quality scores and (3) in subsequent contract years their share of savings will be reduced further,” NAACOS says in a statement.

NAACOS does not believe the one-sided track will be sustainable under the proposed rule. The advocacy group also made a lot of other recommendations for improving the one-sided risk model, including giving Medicare beneficiaries the option to choose to receive their care in an ACO not just be statistically assigned by the CMS computers.

An element from the proposed rule that received praise was the expansion of care coordination tools that will be made available to ACOs in a two-sided risk model. In this regard, the American Telehealth Association (ATA) commended CMS for making telehealth widely available to these ACOs. However, NAACOS and AMGA both urged CMS to make those care coordination tools, like telehealth, available to those in the one-sided risk track too.

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