Industry groups want big ACO changes

February 9, 2015 in Medical Technology

In a letter to CMS Administrator Marilyn Tavenner this past Friday, a who’s-who of healthcare stakeholders laid out a list of improvements to Medicare Shared Savings Program.

[See also: ACOs doomed to fail?]

Signed by nearly three dozen organizations, including the American Medical Association, American Academy of Family Physicians, American Medical Group Association, Medical Group Management Association, National Association of ACOs and Premier healthcare alliance, the  groups said the recommendations “reflect our unified expectation and desire to see the MSSP achieve the long-term sustainability necessary to reduce healthcare costs and improve quality” via the accountable care program.

“While the MSSP program has generated strong interest, sustained and increased participation hinges on the potential financial opportunities being adequate to support the investments needed to improve care and, ultimately, create a program that is sustainable for the long term,” the groups write.

[See also: HHS plans big Medicare reimbursement changes]

They point out that first-year performance data show slightly more than half of participating accountable care organizations – 118 out of 220 –  reduced costs enough to generate savings for Medicare.

Still, only half of that group, “were able to meet the minimum savings threshold required to actually share in the savings,” according to the letter.

The fact that barley a quarter of ACOs get a shared savings payment from Medicare means that “as currently designed, the MSSP program places too much risk and burden on providers with too little opportunity for reward,” the groups argue.

Especially in light of the Department of Health and Human Services’ ambitious new payment reform plans – tying 30 percent of fee-for-service Medicare payments to alternative payment models by 2016, and 50 percent of such payments to alternative payment models by 2018 – changes should be made to the ACO program, according to the letter.

“We urge CMS to: strengthen the assignment of Medicare beneficiaries, establish a more appropriate balance between risk and reward, adopt payment waivers to eliminate barriers to care coordination, modify the current benchmark methodology, and provide better and timelier data,” the industry groups write.

Read their letter here.

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