CMS unveils 'new direction' for MSSP that adds more risk on ACOs

By | December 31, 2018

Dive Brief:

  • CMS announced a “new direction” for the Medicare Shared Savings Program (MSSP) dubbed “Pathways to Success.”

  • The changes will redesign participation options in hopes of encouraging accountable care organizations to take on risk quicker. CMS said ACOs taking on more risk can lead to more savings for the Medicare Trust Funds.

  • The change also includes new tools and flexibilities in the Bipartisan Budget Act of 2018, including new beneficiary incentives, telehealth services and beneficiary assignment methodology choices.

Dive Insight:

MSSP includes 561 ACOs and serves more than 10.5 million Medicare beneficiaries. 

CMS data credited MSSP saving a net $ 314 million to the Medicare Trust Fund in 2017. CMS now wants providers to take on more risk. However, CMS faces an industry not keen on the downside of value-based contracting. In fact, a recent study found that nearly three-fourths of ACOs would leave MSSP if forced to take on risk the following year.

What’s more, taking on more risk doesn’t guarantee an ACO’s success. A recent Avalere study found that experience instead is the key factor.

Nevertheless, CMS is hoping to push ACOs to take on financial risk arrangements sooner. Currently, more than eight out of every 10 MSSP ACOs are in Track 1. Track 1 lets ACOs keep half of the program’s savings without taking on any risk.

CMS wants to accelerate that number, so ACOs face more risk starting on July 1, 2019.

The plan calls for cutting the time ACOs can avoid risk in MSSP. Pathways to Success will reduce the risk from six years to two years for new ACO participants and three years for new, low-revenue ACOs. The latter ACOs can include rural locations.

In an attempt to tempt more ACOs to move away from non-risk tracks, Pathways to Success will offer more rewards for agreeing to task on risk.

Clif Gaus, chief executive of the National Association of Accountable Care Organizations (NAACOS), said in a statement that the group backs CMS’ desire to improve stability with five-year agreement periods and more flexibility in waivers for telehealth and skilled nursing facilities. NAACOS also supports CMS improving shared savings rates for ACOs.

However, the group said it will continue to push CMS not to require ACOs to take on risk sooner.

“These policies may present challenges to providers who want to participate in this important, yet voluntary, Medicare program. NAACOS believes there needs to be movement toward greater risk, and that movement requires an appropriate and reasonable glide path to encourage participation and success,” Gaus said.

Meanwhile, AMGA said in a press release that it’s concerned about the rule not providing enough incentives to maintain current ACOs and attract new ones.  

“CMS is asking ACOs to very quickly move into a risk-based model, which is a policy that AMGA supports,” AMGA President and CEO Jerry Penso said. “But, once an ACO is two-sided and more of its revenue is put at risk each year, it’s possible upside is locked into place at the rate that previously was for upside-only models. We believe this is a missed opportunity to drive providers to the Medicare Shared Savings Program.”

Healthcare organizations have spoken out about the proposal in the past. Nine organizations sent a letter to CMS Administrator Seema Verma in September to voice concerns about proposed changes.

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