From the August 2015 issue of HealthCare Business News magazine
The agency plans to revisit the possibility during the 2017 Medicare Physician Fee Schedule rulemaking process, more than a year from now. This issue has long been problematic because it’s difficult, at best, to manage a population of patients without knowing exactly who your patients are. Ideally, Medicare beneficiaries would not only select a primary care provider, but also select an ACO for their complete care needs. That would truly measure how care is being delivered in an ACO.
HCB News: Another issue of concern for ACOs in the MSSP is the benchmarking process. Do you think that the modifications to the benchmarking process outlined in the final rule will help some ACOs?
AMGA: In the final rule, CMS finalized a policy that will equally weight each benchmark year, and will make an adjustment to account for the average per capita amount of savings generated during the ACOs’ previous agreement period. This should help some ACOs that have had difficulty exceeding their minimum savings rate because they are already very efficient at what they do.
AMGA advocated for CMS to provide a way to account for regional expenditures in the benchmarking process, as well. Many of our member medical groups have told us that a regional component in the benchmark would help them achieve shared savings. CMS plans to examine this issue in greater detail, and states that it will be the subject of a separate rulemaking process this summer.
HCB News: The Centers for Medicare and Medicaid Innovation (CMMI) has recently announced the “Next Generation ACO” demonstration project. What are the goals of this demonstration project?
AMGA: The Next Generation ACO Model is intended to target experienced, high-performing ACOs and test the role that strong incentives to take risk may play in improving the ACO model. These high performing ACOs also will have the opportunity to earn higher savings to incentivize their participation in the demonstration. CMMI also is permitting risk scores to go up by 3%, if necessary, to more accurately reflect the resources utilized to treat beneficiary in these ACOs.
In the MSSP, risk scores can only remain frozen in place or go down, which has been an area of concern. Beneficiaries will also be prospectively aligned with the ACOs in this model. CMMI is recruiting 15-20 ACOs to participate, so the project will be limited in scope, but CMMI hopes this project will help them learn what combination of factors will help ACOs and the Medicare program succeed.
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