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Is CMS “Starving” ACOs?

A former Medicare official recently spoke about the “irony” of the ACO world, noting that CMS is making the deals as hard as they can be—thereby “starving ACOs.”


The official, now a large system president and CEO, said there doesn’t appear to be provider resistance to ACOs; nevertheless, it was time to make some significant changes to the program.


“The difference between now and the 1990s is that providers feel good about the accountable care work that is going on,” he said. The major obstacle for providers remains poor financial incentives, specifically Track 1 of the Medicare Shared Savings Program (MSSP). Track 1 carries only upside-risk, and 95 percent of MSSP ACOs currently are in this track. But from a quality and cost perspective, as well as the financial incentive structure, it doesn’t make sense to participate in Track 1.

The former Medicare official suggested changes that include:


  • Allowing participating providers to earn up to 80 percent, instead of the current 50 percent limit, of shared savings generated in the upside-only MSSP model “for a while”


  • Allowing more physicians to qualify for participation in alternative payment models (APMs)—in the proposed rule, Track 1 MSSP ACOs are excluded


  • Using waivers to give physicians up to five years to get results before forcing them to exit the APM track


  • Making some technical changes to ACO benchmarking


  • Additional shared savings for top performers


  • Relief from sequestration


  • More flexibility to move up the risk continuum


(Source: “Former CMMI Chief Warns CMS Is ‘Starving’ ACOs,” HFMA Weekly News, September 30, 2016)




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