WASHINGTON — Are 66 new Responsible Care Organizations (ACOs) in one year a sign of progress or a disappointing result? It depends on who you ask.
CMS announced last week that 66 additional ACOs had joined the Medicare Shared Savings Program (MSSP) for ACOs in 2022, bringing the total to 483 ACOs. However, this number is only six more than last year’s total of 477, which seems to suggest that 60 ACOs left the program last year (CMS did not respond to an email asking for an explanation of the discrepancy) and 34 less than the 2020 total. 517.
“With one in five health care dollars paid by Medicare, we can strengthen and transform our health care system,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “Accountable care organizations present an invaluable opportunity to move Medicare toward person-centered care.” The agency noted that these ACOs will serve about 11 million Medicare beneficiaries nationwide, up from 10.7 million in 2021.
ACOs are groups of doctors, hospitals, and/or other health care providers who work together to provide better care at lower cost. Under the MSSP, ACOs share savings when the cost of provider care for ACO beneficiaries falls below a predefined threshold. The MSSP offers several different options for ACOs in terms of financial risk; one option only allows “upside risk” in which the plan shares savings but not losses, while other options include a higher level of financial reward but also require ACOs to share any losses that may occur.
The National Association of ACOs (NAACOS) was unimpressed with the CMS announcement. “After several years of stable or declining ACO growth, today’s announcement is disappointing and should send a wake-up call to an administration whose goal is to have all traditional Medicare patients into a model of responsible care by 2030,” the organization said in a statement. . “There are even fewer ACO and ACO patients in the program than there were in 2020.” That year, according to a CMS fact sheet, there were 517 ACOs serving 11.2 million people through the program.
NAACOS suggested several ways to improve the MSSP, including increasing ACO’s shared savings rates, addressing key calibration and risk adjustment issues, allowing more time before demand risk, minimizing administrative burdens and providing more timely and complete data.
Asked to comment further on the results, a CMS spokesperson said in an email that “[w]While we recognize there is still work to be done, CMS’s commitment to increasing the number of healthcare providers in accountable care arrangements has never been stronger. CMS is listening to stakeholders for feedback on how to incentivize greater participation of ACOs in the Medicare Shared Savings Program and we look forward to the next Shared Savings Program application round which opens this summer. . »
One possible reason why interest in the MSSP is declining may be that ACOs and other entities are more interested in a new model called direct contracting, which is being introduced by the Center for Medicare & Medicaid Innovation at CMS. The Direct Contracts Demonstration Program offers three different types of direct contract models, including “capitation and partially capitation population-based payments that move away from traditional fee-for-service,” according to a fact sheet. information.
The program is also trying to broaden participation to include “organizations new to Medicare fee-for-service, such as physician-run organizations that currently operate exclusively under the Medicare Advantage program,” according to CMS. These organizations, which could include ACOs run by physicians, insurance companies and health systems, would agree to provide care to a number of traditional Medicare beneficiaries in a geographic area for a specified amount.
“Regardless of the growth in direct contracts, the lack of new MSSP participation is extremely concerning,” wrote David Pittman, senior policy adviser for NAACOS, in an email. “Yes, direct contracting will increase Medicare’s ‘responsible care’ footprint, but declining interest in the MSSP — the permanent, statutory ACO model — needs to be addressed by CMS and Congress.”
America’s Physician Groups (APG), a lobbying organization for physician-led ACOs, also expressed concern about MSSP listing. The findings “were a mix of promising trends and some areas of concern where things could potentially be improved,” Valinda Rutledge, the group’s executive vice president of federal affairs, noted in an email.
“There are many APG members in the MSSP, but many are considering making the jump to the direct procurement program due to those program elements that need to be improved,” she added. “Moving forward, it is important that the MSSP program not only seeks to maintain stable growth, but encourages more participants to follow its risk-based pathways.”