The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule making changes to the Medicare Shared Savings Program, including a new risk model for use by participating accountable care organizations (ACOs).
Comments on the 429-page proposed rule, published in the Dec. 8 Federal Register, are due Feb. 6, 2015. CMS said the proposal will improve the program “through a greater emphasis on primary care services and promoting transitions to performance-based risk arrangements.” The rule would update a 2011 final rule on ACOs.
CMS said the proposed rule will give more flexibility to ACOs seeking to renew their participation in the program. CMS is proposing to give ACOs the option of a longer lead time to transition to a two-sided (that is, sharing of savings and losses) performance risk model after their first agreement period, the release said. ACOs also would have the opportunity to renew under the one-sided model for one additional agreement period.
More Risk Encouraged
The agency also is encouraging ACOs to take on greater performance-based risk and reward by proposing to create a new two-sided risk model, called “Track 3,” which integrates some elements from the Pioneer ACO model, such as higher rates of shared savings. The Pioneer ACO model is for providers already experienced in coordinating care for patients across care settings.
“We are seeking comments on a number of care coordination tools that would make two-sided performance risk models more attractive to ACOs such as expanded use of telehealth, beneficiary attestation, and more flexibility around post-acute care referrals to help ACOs better coordinate care for beneficiaries using these services,” the press release said.
New Payment Methodologies
CMS also is seeking comment on alternative methodologies that would make ACO benchmarks for determining shared savings and losses gradually more independent of the ACO’s past performance and more dependent on the ACO’s success in being more cost-efficient relative to its local market, the agency release said.
“For example, we are considering whether shared savings received by an ACO should be added back to the benchmark in future performance periods,” the release said. The agency also is proposing to streamline the process for ACOs to access beneficiary claims data necessary for health care operations such as quality improvement activities and care coordination while retaining the opportunity for beneficiaries to decline to have their claims data shared with the ACO.
The Shared Savings Program now includes more than 330 ACOs in 47 states, providing care to more than 4.9 million beneficiaries in Medicare fee-for-service, according to CMS.
Takeaway: CMS is proposing some changes to its Shared Savings Program, including a new two-sided risk model dubbed “Track 3.”
