Oct. 8-12: ACO Changes Urged for Consideration by Administration, Congress

Some ACO supporters want CMS to reconsider proposed changes that they believe will undermine Medicare’s primary ACO program.

Oct. 3—Healthcare industry leaders will gather next week at various meetings that will include discussions of high-profile accountable care organization (ACO) programs. The Medicare ACO program particularly needs changes, providers told federal officials this week.

At next week’s annual conference of the American Hospital Association’s (AHA’s) Society for Healthcare Strategy and Market Development and at the America’s Physician Groups Colloquium 2018, ACOs and their future are likely to figure prominently.

Senators were urged during an Oct. 3 hearing to make a series of legislative changes to the primary Medicare ACO program, known as the Medicare Shared Savings Program (MSSP).

Sean Cavanaugh, chief administrative officer for Aledade Inc., an ACO advisory company, told members of the Senate Aging Committee that needed ACO changes include moving to a benchmark methodology similar to that used in Medicare Advantage.

Other vital legislative changes, Cavanaugh said, include an end to statutory requirements that rural providers in ACOs take on “meaningful risk,” and elimination of regional benchmarks for rural providers that effectively “punish” them.

The Centers for Medicare & Medicaid Services (CMS) introduced a regional benchmarking approach in 2017 to account for regional trends, and in an August proposed rule sought to accelerate the transition to the new benchmarking system.

“The regional benchmarking methods also inadvertently introduced a new problem that systematically disadvantages rural ACOs by including their population in the regional comparison group,” Cavanaugh said. “Without fixes, the benchmark methodology will continue to favor urban ACOs with high historical costs.”

Administrative Changes

That hearing took place after nine national organizations, including three national hospital groups, wrote a Sept. 20 letter to CMS urging a series of changes to the proposed overhaul of the MSSP.

The groups, which included America’s Essential Hospitals and Premier, warned that the proposed ACO changes “would have unintended consequences of undermining the broader shift to value-based care.”

The ACO supporters were most concerned with the proposals to shorten from six years to two years the period of upside-only risk for new ACOs and to cut in half—from 50 percent to 25 percent—the shared savings rates for those ACOs.

In a Spring 2018 survey, more than 70 percent of ACOs said they would leave the program if they had to take on mandatory risk for 2019.

In a September speech, Alex Azar, secretary of the U.S. Department of Health and Human Services, said federal officials have seen the best results from ACOs that took on two-sided risk and from physician-run ACOs, as opposed to those led by hospitals. But his repeated theme was the need for more “accountability.”

“Without real accountability, we’re just offering bonuses on top of payments that may be too high already,” Azar said. “That’s why we have now proposed to simplify the ACO system into two tracks, requiring them to take on risk sooner.”

If increasing ACOs’ downside risks means fewer ACOs, “that could be OK,” said Adam Boehler, director of the Center for Medicare and Medicaid Innovation at CMS.

Sunday, Oct. 7

National Home Care and Hospice (NAHC) Conference and Expo, Grapevine, Texas, (through Oct. 9). Learn more.

American Society of Health Care Risk Management annual conference, Nashville (though Oct. 10). Learn more.

Monday, Oct. 8

Cerner Health Conference, Kansas City, Mo. (through Oct. 11). Learn more.

Deadline to review performance data on quality measures in the Inpatient Rehabilitation Facility (IRF) Provider Preview Learn more.

Deadline to review performance data on quality measures in the Long-term Care Hospitals (LTCHs) Provider Preview. Learn more.

 MANOVA summit, Minneapolis (through Oct. 10). Learn more.

Tuesday, Oct. 9

Investment and M&A Opportunities in Healthcare conference, Chicago (through Oct. 10). Learn more.

Web conference by the Advisory Board titled “Oncology Market Trends.” Learn more.

Webinar by America’s Health Insurance Plans (AHIP) titled “Building Powerful Digital Health Interventions That Work.” Learn more.

Webinar by AHA titled “7 Investments Companies Can Make to Improve Employee Health and Their Bottom Line.” Learn more.

Wednesday, Oct. 10

Webinar by HFMA titled “Practical Strategies for Improving Patient Financial Engagement.” Learn more.

Webinar by AHIP titled “Consumer-Directed Health: Improve Employer Partnership, Member Engagement.” Learn more.

Webinar by the American Medical Association titled “Opioid Safety Project Webinar Series—Non-Pharmacologic Approaches to Pain Management.” Learn more.

Summit by the Alliance for Health Policy titled “Aging in America.” Learn more.

Thursday, Oct. 11

Webinar by AHIP titled “Total Population Management: The Missing Link in Population Health.” Learn more.

Web conference by the Advisory Board titled “Clarify Your Cultural Aspiration.” Learn more.

Webinar by AthenaHealth titled “The mobile M.D.: Clinical support for more efficient physicians.” Learn more.

Friday, Oct. 12

Deadline to recommend healthcare leaders to participate in HHS Deputy Secretary Eric Hargan’s Innovation and Investment Summit. Learn more.