From the August 2015 issue of HealthCare Business News magazine
HCB News: Do you think the new Track 3 finalized in the regulations will attract participants?
AMGA: Track 3 will offer some ACOs that are very confident in their ability to manage risk the ability to share in up to 75% of their savings with Medicare, while taking commensurate risk. In exchange for this level of risk, CMS is providing Track 3 ACOs a prospectively assigned patient population, so they will know exactly which of their beneficiaries are in the ACO, which will offer a huge advantage in managing their care.
Track 3 ACOs can also apply for a waiver from the 3 day hospital stay requirement for skilled nursing facility admissions, when it’s clinically appropriate to do so. We think this particular waiver, among others, should have been extended to all ACOs, since all ACOs are taking on significant risk in establishing their programs, but CMS chose a very narrow path by offering it only to Track 3 ACOs. It remains to be seen what the appetite among medical groups will be for Track 3.
HCB News: Why do you think CMS should have expanded the use of waivers in the MSSP more broadly, outside of the skilled nursing facility 3-day hospital stay requirement in Track 3?
AMGA: The proposed rule discussed the possibility of waivers for the skilled nursing facility 3-day rule, certain Medicare telemedicine billing requirements, the homebound requirement under the home health benefit, and referrals to post-acute care settings. The agency solicited stakeholder feedback on all of these, and AMGA urged the expansion of their use across all ACO tracks, yet the agency chose a very narrow application of them in the final rule, as we mentioned previously.
AMGA believes that all Medicare patients who are attributed to ACOs should have access to these benefit design changes that would permit clinical decision making to appropriately inform the health care they receive. AMGA also believes that risk-taking is inherently a part of participating in ACOs, no matter what track they are in. The investments necessary to participate in the program, at any level, are considerable and represent significant financial risk. More work must be done to extend the ability of all ACOs to incorporate waivers.
HCB News: AMGA has long been concerned about the beneficiary attribution problems in the MSSP program. Did the final rule do anything to improve the situation?
AMGA: Despite asking for stakeholder input in the proposed rule, CMS elected not to make any changes to beneficiary attribution in its final rule. AMGA, along with other stakeholders, asked them to pursue voluntary alignment for ACO beneficiaries but CMS stated a desire for additional testing of any changes to its methodology in the Pioneer ACO program before making any decision.
