CMS just released a new proposed rule for the Medicare ACO program (SSP). Here's my thread on the major parts of the new rule (summarized in a @health_affairs blog by Seem Verma) and potential implications. Brief version: huge changes; some good, more bad.
healthaffairs.org/do/10.1377/hbl…
healthaffairs.org/do/10.1377/hbl…
One set of major changes: benchmarking. These include incorporating regional benchmarks so as not to penalize ACOs with a large market share who are causing their region's spending to slow. Good thoughts in this thread on how this matters.
Also changes to risk adjustment. Combined with benchmarking, this moves MSSP benchmarks closer to Medicare Advantage, which many have argued would be a good thing. (Post some links if you are one of those people, I'm not expert in the key details here).
BUT (and this is a HUGE "but"): it also reduces the number of years an ACO can be upside only from 6 to 2, and increasing contracts from 3 to 5 years. So new ACOs signing up are joining for 5 years, and take on downside risk in year 3. Existing ACOs get 1 year of upside.
Two implications to this clear from my and others' work: First, many ACOs will quit or not sign up. Program participation will shrink considerably because many providers don't feel capable of taking on downside risk, even if they are saving.
(We hear this in qual interviews)
(We hear this in qual interviews)
Second, providers likely to increasingly turn to management partners who will take on the risk-- but will also take a cut of any savings. Jury out if this is a good deal, or an arrangement we think is good for health care.
Finally, for comedic value, the attempt to write about ACOs for the popular press. ACOs described as "Care coordination program" with "teams" . Reminds me of conversations with friends and family ("So... an ACO is trying to pay doctors differently...")
washingtonpost.com/national/healt…
washingtonpost.com/national/healt…
