Physician Practice

CMS final rule for MSSP focuses on primary care services, greater flexibility to grow program

Physician Practice Insider, June 16, 2015

by John Castellucio, Editor

Accountable Care Organizations (ACO) have been enjoying some early successes, and CMS wants to capitalize on them as it moves forward with revisions to its introductory program that switches traditional fee-for-service Medicare providers over to ACOs.

Following public comments on proposed regulations this past winter, CMS released a finalized rule on June 4, 2015 that updates the Medicare Shared Savings Program (MSSP) by enhancing the focus on primary care services and increasing flexibility in the program to grow overall participation.

The changes, in addition to codifying existing components of the program, incorporate features from the pilot Pioneer ACO Model, streamline data sharing between CMS and ACOs, establish a new waiver, and refine policies and incentives for ACOs to meet their benchmarks.

In the June 4 announcement, CMS pointed to early MSSP results released in November 2014 that indicated participating ACOs improved quality of care for beneficiaries as they improved performance in 30 of 33 quality measures in the initial two years of the program. A separate independent evaluation of the Pioneer ACO Model released in May showed the project surpassed expectations and generated $384 million in savings during its first two years while still delivering high quality care.

HHS also announced in January that it would seek to tie 30% of Medicare payments to alternative payment models that reward quality and value, such as ACOs, by 2016 and increase that to 50% by 2018.

A key aspect of the final rule highlighted by CMS is the creation of a new track based on successful features of the Pioneer model, which includes higher payment rates of shared savings, prospective assignment of beneficiaries, and opportunities to use new care coordination tools.

ACOs will also have easier, secure access to data on beneficiaries to improve quality and coordination of care, and there will be a waiver of a three-day stay Skilled Nursing Facility rule for beneficiaries who are prospectively assigned to ACOs under the new track.

The final rule also refines policies for resetting ACO benchmarks to “help ensure that the program continues to provide strong incentives for ACOs to improve patient care and generate cost savings,” CMS said in the June 4 announcement. CMS plans to propose additional revisions to the benchmarking methodology later this year.

As the federal government shifts away from fee-for-service healthcare payment models to models that reward quality of care and affordability, financial incentives play a key role in that process, and that’s a big part of how ACOs function.

MSSP, which has voluntary participation and accepts applications annually for the three-year program, was created under the Affordable Care Act of 2009. CMS says more than 400 ACOs that serve more than seven million beneficiaries now participate in the program.

“Accountable Care Organizations have shown early but exciting progress in improving quality of care while providing more patient-centered care at a lower cost,” said CMS Acting Administrator Andy Slavitt in a statement. “The ACO rules today strengthen our ability to reward better care and lay the groundwork for more providers to become successful ACOs.”


Most Popular