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AHA to CMS: Make ACO Participation Easier

April 21, 2014
by Gabriel Perna
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The American Hospital Association (AHA) wrote a letter to the Centers for Medicare and Medicaid Services (CMS) recently, imploring the government agency to make it easier for providers to join the Pioneer Accountable Care Organization and Medicare Shared Savings Program (MSSP) initiatives.

According to the AHA, the ACO and MSSP programs currently put too much risk and burden on providers with too little opportunity for reward in the form of shared savings. They ask CMS to improve ACO participation with several changes including improving the timeliness and accuracy of performance data and setting a standard minimum savings rate of no more than 2 percent (regardless of the beneficiary total).

The AHA also request that the CMS create more “achievable thresholds” in the early years, implement technical adjustments to the benchmark to account for policy changes, allow for an opt-in by beneficiaries, allow to vary beneficiary cost sharing, and simplify and align quality measures. They also ask that there be “multiple” paths to accountable care, so that organizations take on more financial risk when they are ready for it.

“The AHA believes that very few – if any – additional health care organizations will apply to participate in the Pioneer ACO Model as currently constructed,” the organization’s senior vice president of public policy, Linda Fishman, says in the letter to the CMS. She pointed to the nine organizations leaving the Pioneer ACO program in its first year as an example of this.

The AHA says that the first two years of the Pioneer program, those involved should be able to take part in the MSSP. Those that earn shared savings will move to population-based payments in year three and can continue through optional years four and five. Those who go for population-based can either select a selected percentage of either their expected Medicare Parts A and B fee-for-service revenues or their expected Part B fee-for-service revenues, AHA says.

“The ACO model is a good step forward towards transforming our delivery system, but its current structure is not sustainable given diminishing returns for providers,” Fishman writes.


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