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Providers warn Feds about proposed changes to MSSP



FierceHealthcare reports:

“Provider groups had plenty to say about the proposed changes to the Medicare Shared Savings Program (MSSP) that are likely to drive out a portion of Accountable Care Organizations (ACOs) if finalized.

A new survey by the National Association of ACOs (NAACOS) released this week shows that 60% of ACOs currently in the MSSP wouldn’t enter the program under the proposed structure, which includes reducing shared savings from 50% to 25% and shortening the amount of time ACOs can remain in a one-sided risk model from six years to two years.

Nearly half of the ACOs surveyed said they are likely to continue even if those changes take effect. More than one-third (36%) said they were unlikely to continue under the proposed structure, and 16% took a neutral stance.”

To read the whole article, please hit this link.


Next Generation ACOs form coalition

FierceHealthcare reports in a new article:

“Next Generation ACOs take on greater financial risk than other programs, such as the Medicare Shared Savings Program, and in return are offered greater flexibility for care coordinationBut they’ve also faced blowback, with some calling for these models to be scrapped or severely overhauled because the promised savings slow to materialized

So 29 participants in the Centers for Medicare & Medicaid Services Next Generation ACO program—including Dartmouth-Hitchcock Medical Center, Henry Ford Health System, Mission Health, Carillion Clinic and Trinity Health—are teaming up to work with the agency to ensure the model stays in place for the long-term.”

To read the piece, please hit this link.


Feds to ask ACOs to take on more risk

From FierceHealthcare:

“A long-awaited proposal from the Trump administration will ask Accountable Care Organizations (ACO) to take on more risk going forward, a move that is likely to drive providers out of the program.

The proposed rule (PDF) issued by the Center for Medicare & Medicaid Services (CMS) on Aug. 9, shrinks the amount of time ACOs can be in an upside only model to two years. Currently, 82 percent of ACOs participating in the Medicare Shared Savings Program (MSSP) are in an upside only model.

Additionally, those in a Track 1 upside only model would only be able eligible to take in 25 percent of any savings. Under the current program, Track 1 ACOs take a 50 percent cut. In an upside model, ACOs get a portion of any savings generated in treating patients but are still paid by CMS if they incur losses.”

To read the full Fierce article, please hit this link.

Value-based programs may hurt providers that serve a lot of poor people


A new JAMA report that reviewed the first year of the Medicare Physician Value-Based Payment Modifier (PVBM) Program  found that providers who served “more socially high-risk patients {who are mostly lower socio-economic class} had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs.” This led to fewer bonuses and more penalties for high-risk practices.

The authors said  that value-based payment programs may financially harm practices that “disproportionately serve high-risk patients.”

CMS created the PVBM to measure the quality and cost of care provided to Medicare beneficiaries. Payments are based on providers’ performance on quality and cost measures.

Healthcare Dive commented:

“The JAMA study’s finding that more medically high-risk patients had lower quality and higher costs is eye-opening. Those patients are usually the most costly and payment models will need to figure out ways to reduce those costs while not penalizing physicians if value-based programs are successful. A payment model that only lowers costs and improves care to healthy people won’t move the needle.

“Even worse, if physicians are penalized, what incentive do doctors have to care for the sickest Medicare patients?

“The JAMA report will likely not quell physician fears about how value-based programs may lead to lower Medicare payments. It also won’t satisfy individuals concerned that changes to the healthcare system may harm the most vulnerable, which is always a worry when there are major healthcare changes.”

“One key finding about value-based care so far has been that experience in the model plays an important role in whether a provider has success. Organizations with the most success under value-based programs have often spent years creating clinically integrated networks, James Landman, director of healthcare finance policy at the Healthcare Financial Management Association, recently told Healthcare Dive.

“If you look at the data for the Medicare Shared Savings Program, which is the biggest of the ACO {Accountable Care Organization} programs under CMS, there is a correlation between time spent in the program and the ability to generate savings,” Landman said.”

To read the JAMA report, please hit this link.

To read the Healthcare Dive analysis, please hit this link.

Medicare ACOs seen gaining this year


Avalere Health, the  consulting firm, sees financial-risk-bearing Accountable Care Organizations gaining more traction and popularity this year. It says that “providers will feel increasingly comfortable with assuming financial risk in exchange for larger incentives” as more than 9 million Medicare beneficiaries are covered by a total of 480  (ACOs), including 99 new participants, in the Medicare Shared Savings Program (MSSP).

The number of ACOs participating in the Next Generation ACO Model launched by the CMS Innovation Center has more than doubled to 45 this year, from 17 in 2016..

Of the 525 ACOs serving Medicare beneficiaries, 87 are in risk-sharing arrangements that include bearing financial losses if certain cost targets aren’t reached.

Healthcare Dive noted: “Expansion of MSSP and growth in the number of risk-sharing ACOs is due in large part to the passage of MACRA, which is accelerating the trend toward value-based initiatives through the Quality Payment Program. So far, it seems that MSSP has been successful saving a total of $466 million in 2015 and more than $1.29 billion total since 2012.”

“As Congress considers health reform, there is some doubt surrounding the future of value-based initiatives like MSSP, which was established by the ACA. One reform floated by Republican leadership could be detrimental to progress made toward value-based care.”

“This approach would cause Medicare to function more like traditional markets, which would increase financial responsibility borne by beneficiaries and leave improvements to market forces rather than government regulators.”

To read the Avalere report, please hit this link.

To read the Healthcare Dive analysis, please hit this link.



Looking at the future evolution of the MSSP


In HealthcareDIVE,   Farzad Mostashari, M.D., and Travis Broome write about the continuing evolution of the Medicare Shared Savings Program. Dr. Mostashari is founder and CEO of Aledade Inc., where Mr. Broome is the lead policy person. Dr. Mostashari is the former national coordinator for health information technology at the U.S. Department of Health and Human Services.

”{M}ore investment and more fine-tuning will be required if we are to strengthen the MSSP and use it to help power the transformation of Medicare to a value-based system.

”First, CMS needs to tailor the risk for MSSP ACOs so that it is enough to motivate, but not sink a small practice. It’s critical that the risk small practices take on bears some relationship to the financial resources of the ACO and its members. If it’s too much so that a bad year that happens because of an external event – such as an epidemic or disaster – can sink even the most well-intentioned practice, then no one will enter into an ACO arrangement.”

“”Second, we need an accurate way to measure whether or not an MSSP ACO creates value. The best way to do that is through a difference-in-difference approach. In this, the key question asked is: Did a Medicare beneficiary get better care at lower cost in the ACO than if that same Medicare beneficiary had not been in the ACO? To get closer to this difference-in-difference approach, CMS needs to move away from national inflation updates and artificial risk-scoring methodologies to regional inflation updates and direct risk scoring.”

”Third, CMS should continue to seek to simplify the program. For example, while we appreciate the work that was done in Track 1+, it is quite possible all of the same benefits could have been accomplished by adding just a few lines of changes to Track 2 without the need to create a whole new track. This would have been both simpler and created a better business case for physicians to move towards risk.”

To read more, please hit this link.

CMS releases stronger incentives to join ACOs

CMS has released final regulatory revisions  to strengthen incentives for Accountable Care Organizations in the Medicare Shared Savings Program.

CMS Acting Administrator Andy Slavitt said the changes  will “encourage more physicians to improve patient care by joining ACOs, while also refining how the program measures success, so that current participants are better rewarded for quality.”

Mr. Slavitt said the changes will also help physicians prepare for the new Quality Payment Program That program will hold providers to unprecedented accountability not just for reporting, but also, among large physician groups, for performance on a broad range of behaviors.

Here, according to Becker’s Hospital Review, are five takeaways from the MSSP ACO final rule.

1. “CMS modified the process for resetting benchmarks used to determine ACO performance.”

2. “CMS removed the adjustment that explicitly accounts for savings generated under an ACO’s prior agreement period.”

3. “The rule includes a phased-in approach to implementation.”

4. “CMS finalized an additional option for ACOs participating under Track 1 to apply to renew for a second agreement period under a two-sided model.”

5. “The rule establishes timeframes and criteria for ACOs to appeal CMS’ calculation of bonuses and penalties.”


A look at MSSP quality measures



This HealthAffairs article “dives into the pool of ACO quality measures,” and and looks at Medicare Shared Savings Program Year 2 performance metrics.

The authors conclude:

“The findings indicate the per-member benchmark is the strongest predictor of receiving savings and the amount of savings. But while success in savings to date is largely influenced by the established per-member benchmark, several quality measures are logically related to the magnitude of savings. Opportunities remain for improving patient outcomes. Additional time and experience in selecting quality metrics may be required to strengthen the relation measures of care quality and cost savings.”


Absorption of PCPs helps R.W. Johnson Health System toward goals


Robert Wood Johnson University Hospital, in New Brunswick, N.J. 

This piece in Hospitals & Health Networks discusses how New Jersey’s Robert Wood Johnson Health System,  “Rather than build a network and set of processes around a particular objective, such as participating in the Medicare Shared Savings Program… set a course to pursue the Triple Aim concept of lowering costs, improving clinical results and improving population health. …Physician alignment necessary to move smoothly into a systemwide set of health care delivery goals was aided by a proliferation of primary care physician employment by RWJ, from zero employed practices in 2012 to 110 today.”

2 big Ohio systems merging their ACOs


Two Ohio health systems will jointly contract for accountable care with health plans under a newly created clinically integrated network with broad geographic reach in the Buckeye State.

Cincinnati-based Mercy Health, formerly Catholic Health Partners, and Akron-based Summa Health said that each system’s Accountable Care Organization would join a new organization, Advanced Health Select — a clinically integrated network.

Other large regional systems, such as, in Michigan, Ascension Health and Trinity Health,  have been working to broaden their contracting in similar ways

The idea in the Ohio case is to build on ACOs’ success in the Medicare Shared Savings Program and the  systems’  total of  $100 million invested in the last four years in data analytics, information technology and care coordination.

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