Thread by @AledadeACO

During our #webinar on the #MSSP proposed rule we had a Q&A with @Farzad_MD and @Travis_Broome. We're sharing the most asked questions and answers below.

See the full webinar here: register.gotowebinar.com/register/28290…
#MSSPruletalk

Q: Do "low-revenue" ACOs have to enter "Enhanced" track if they have prior experience?
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

Q: Do percentage regional benchmarks apply to new start ACOs? What does percentage benchmark mean?
A: Regional benchmarks will now start in agreement period 1 (35% for efficient, 25% for inefficient). Independent practices tend to be more regionally efficient!
@HRDahlman

Q: Can you please elaborate on regional benchmarks?
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

Q: What is the formula for determining high and low revenue ACOs?
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)

Q: Is the min saving rate eliminated and if so does this help offset the decrease in saving %?
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

Q: How many high revenue acos does Aledade have?
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.
@drsp27

Q: Can an existing ACO add new providers on their panel before expiration date?
A: Any existing ACO, including 2016 starts, can add providers to their existing agreement-- must be done by the end of September

Q: Do payments made in beneficiary incentive program go into the financial rec?
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
@AnnetteDuBard

Q: if ACO improves risk by 3% in first year, can it benefit from that benchmark adjustment for the remaining 4 years?
A: Yes, if it stays that high it would be adjusted up for the entire contract (5 years).

Q: If we are in an ACO for 2018 and plan to join aledade for 2019, how much effort is needing in finishing out our 2018 performance?
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

Q: How does regional benchmarking affect ACOs with participants in different parts of the country?
A: Regional benchmarking will include a weighted average of county-level beneficiary shares

Q: How are CPC+ and Advanced BCPI programs treated?
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

Q: If an ACO is in Track 1 and entered their 2nd contract in 2015, can they change their contract or join another ACO in January 2019?
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.

Q: Will you still be able to move practices from one ACO to another under this model?
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.

Q: Is downside risk measured from baseline or the MLR?
A: Baseline (just like there are first dollar savings, it is first dollar losses)

Q: I'm currently in an ACO, but was planning on switching ACO's 1/1/19. How does this affect my practice now?
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

Q: Can you only move sequentially A-B-C etc. each year? Or can you start/move further ahead faster?
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
@AR_Wess

Do you have a question about the #MSSP proposed rule our Q&A didn't answer? Watch our webinar or tweet us your questions!

register.gotowebinar.com/register/28290…

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