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More Changes to the MSSP ACO Rules

Posted in Accountable Care Organizations, Affordable Care Act, Home Healthcare, Hospitals and Institutions, Legislation and Public Policy, Medicare and Medicaid, Reimbursement Matters

The Centers for Medicare & Medicaid Services (CMS) is expected to publish a proposed rule on February 3 that will incentivize accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) to improve their performance by changing the benchmarks on which CMS evaluates them.

Under the current ACO model, an ACO’s results are measured against an annual cost target based on historical data, rather than on year-over-year improvement. Using this method, ACOs with high baseline costs have significant room for improvement, while those with low baseline costs do not. CMS proposes to: 

    • Move away from assessing ACO benchmarks based on national historical spending, and instead analyze trends in regional fee-for-service costs to encourage ACOs to invest in care coordination and quality of care improvements. 

    • Offer an alternative participation option to encourage ACOs to enter into performance-based risk arrangements earlier in their MSSP participation. 

    • Establish policies for reopening payment determinations to make corrections after financial calculations have been performed to determine an ACO’s shared savings.

The deadline for comments on the proposed rule will be April 3.

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