AMA, AHIP, and Others Oppose Upside-Only ACO Changes for MSSP

The news of proposed changes to accountable care organizations’ financial risk has gotten people all over the healthcare field in the U.S. involved in the discussion. The Center for Medicare and Medicaid Services has recently come out with a proposal to limit the amount of time accountable care organizations have to assume financial risk as part of their bargain with the Medicare Shared Savings Program (MSSP). Originally the timeline was six years before ACOs began assuming financial risk. The proposal shrinks that timeline to two years.

Currently, ACOs are “upside only”—that is, they receive money when they deliver well on MSSP’s goals but they don’t lose money if they don’t. MSSP’s proposed changes would shorten the amount of time ACOs have before they also assume “downside” risk of losing money if they don’t meet quality or savings goals.

“After six years of experience, the time has come to put real ‘accountability’ in Accountable Care Organizations,” wrote CMS Administrator Seema Verma when announcing the proposed overhaul. “Medicare cannot afford to support programs with weak incentives that do not deliver value. ACOs can be important component of a system that increases the quality of care while decreasing costs; however, most Medicare ACOs do not currently face any financial consequences when costs go up.

However, healthcare organizations don’t share Verma’s beliefs about the benefits of risk assumption by ACOs. The latest organizations to come out against the shortening of the downside risk timeline are the American Medical Association, Medical Group Management Association, and Health Care Transformation Task Force.

“Our recommendations reflect our unified desire to see the MSSP achieve the long-term sustainability necessary to enhance care coordination for Medicare beneficiaries, lower the growth rate of healthcare spending, and improve quality in the Medicare program,” the groups recently wrote to Verma. “Program changes that deter new entrants would shut off a pipeline of beginner ACOs that should be encouraged to embark on the journey to value, which is a long-standing bipartisan goal of the Administration and Congress and important aspect of the Quality Payment Program.”

Not only that, but a Spring 2018 survey revealed that more than 70 percent of MSSP ACOs that must assume downside financial risk by 2019 because of program rules were likely to quit the MSSP.

ACOs in general have been against the new timeline, but one ACO is different from the crowd. Aledade CEO Farzad Mostashari has posted a number of tweets stating that he and Aledade are actually in favor of the proposed changes to MSSP. For example, moving to downside financial risk helps to “weed out ACO squatting,” he wrote in one tweet.

Read the full story on RevCycle Intelligence.