Centers for Medicare and Medicaid Services will invest in rural and underserved accountable care organizations, and introduce more flexibility to the Medicare General Savings Program with the aim of launching Enrollment has stagnated and health equity gaps are closing.
CMS will provide enhanced shared savings to low-revenue ACOs and allow greater flexibility for those taking risks based on performance, the agency announced in a final rule. announced on Tuesday. CMS also finalizes adjustments to the ACO standards to encourage long-term participation. Regulators predict the changes will result in $650 million in higher shared savings payments to ACOs.
These updates are part of the physician fee schedule, which also reduces the costs of paying doctors, loosening oversight requirements for medical practitioners.
“Today’s final changes to Medicare’s largest ACO program deliver a win for patients and will absolutely help providers deliver responsible care to more patients,” said Chairman. President and CEO of the National Association of ACOs, Clif Gaus said in a press release.
The trade group represents providers participating in Medicare’s population health payment and distribution models, including the General Savings Program, which allows physicians to form ACOs to coordinate care. care for individuals enrolled in fee-for-service Medicare. Participation in the Medicare General Savings Program is voluntary, but participating providers may earn bonuses based on quality and cost metrics.
CMS reviewed the program’s rules after finding unfair representation of minority patients and higher-spending populations in the program, along with stability in total beneficiaries. benefits are assigned to ACO through the model.
The agency aims to reverse these trends by providing funds to incentivize suppliers in rural or underserved areas to form new ACOs. CMS will provide eligible ACOs with one-time payments of $250,000 and quarterly payments for the first two years of the 5-year agreement. Distributed quarterly payments will be determined according to the needs of the beneficiary. Service providers must spend all advanced payments to improve infrastructure, increase staffing, or provide care to underserved patients. ACOs will be required to disclose enhanced payments received and spent.
CMS will collect the money back when the ACO starts earning the shared savings. Funds will not be refunded if the ACO fails to reach the savings, unless the ACO terminates the agreement early. CMS will start accepting applications for advanced payments next year and distribute them in 2024.
The agency also tweaked the ACO benchmarking system to promote long-term participation. CMS’s previous policy linked the ACO’s standard rate to the amount they saved in previous years. ACOs that save more each year face increasingly high standards, making it difficult to achieve the savings needed for the program to be profitable.
CMS has completed the application of a potential external factor to the ACO benchmark, along with pre-saving adjustment in historical benchmarks. The agency also reduced the negative regional adjusted limit of national per capita spending on Medicare Part A and Part B services for transferable beneficiaries to -1.5%, from – 5%.
For care management facilities providers, ACOs inexperienced with performance-based risk will be able to enter into 5-year agreements under a mutual savings model. , with the possibility of a two-year extension. Additionally, some low-turnover ACOs in the base program that meet certain quality standards can share in savings even if they don’t remove the minimum savings rate.
CMS also finalized policies to improve risk management for ACOs, incorporate health equity as a measure of quality, and reduce administrative burden by removing the requirement that organizations submit documents. marketing to consider. CMS also relaxed the requirements for the skilled nursing facility’s three-day waiver.
CMS also defers its policy on payment for management visits and breakdowns for one year. Clinicians who provide split visits will further choose from four factors to determine the content of those visits.
The National Association of ACOs cheered CMS’s move to offer pre-shared savings, adding a health equity adjustment that factored in ACO’s previous performance to lower their benchmark by time and give ACOs more time before they are forced to accept financial risks. But the organization didn’t get everything on its wish list.
The trade group criticized CMS’s lack of action on what it called a “rural glitch”, whereby ACOs no longer benefit from regional adjustments when reducing their spending on diseases. designated personnel. The association also criticized CMS for using a potential outside of projections for ACO benchmarks for their financial spending goals, and suggested that more than a third of ACOs would be harmed by the change. change this.
