A: No, a low-revenue ACO that is inexperienced with risk can be in the BASIC glide path for agreement period 1 and Level E for their second agreement. More nuanced if experienced with risk
A: Regional benchmarks will now start in agreement period 1 (35% for efficient, 25% for inefficient). Independent practices tend to be more regionally efficient!
A: In the old rules the benchmark was can you beat yourself? It was based on your historical costs trended forward. Now 35% of your score (budget) comes from what other Medicare costs in your county are
A: Total FFS revenue is: less than 25% of the total FFS expenditures for assigned beneficiaries (low revenue); more than 25% of total FFS expenditures (high revenue)
A: ACOs can choose their MSR/ MLR. If it is lower, they will share more frequently if they get savings. Lowering gameshare means they would share less
A: We think we don’t have high revenue ACOs (haven’t run the numbers). Low revenue practices have less access to capital and are less able to whether downside risk.
A: Any existing ACO, including 2016 starts, can add providers to their existing agreement-- must be done by the end of September
A: Incentive payments have to be paid out of your [ACO] pocket; will not be included in final reconciliation since it is not a payment made by CMS
A: Yes, if it stays that high it would be adjusted up for the entire contract (5 years).
A: Still 4 months left in the performance year, you always want to do your best! Push hard on everything you’re doing and good things happen
A: Regional benchmarking will include a weighted average of county-level beneficiary shares
A: Rule doesn't speak to these, assumption that it continues as is; if we’re sure of the number by the time we settle up on savings, they count as cost of care
A: There will be no application process for a January 2019 start. Contracts that expire in 2018 can end in Dec or be renewed for 6 months.
A: In short, yes. There are some nuances of what happens if an ACO crosses a threshold of having more than 50% of previously participating/ experienced physicians though.
A: Baseline (just like there are first dollar savings, it is first dollar losses)
A: If it was an existing ACO, you can still be added to their participant list. If it was a new ACO you’ll have to wait until July 2019 when their contract begins
A: You can start wherever and move further ahead faster. You can also terminate your BASIC contract at any point and move to ENHANCED without having a “sit-out” period