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CMS Proposed Rule on Provider Payments in Medicare Shared Savings Program

The Office of Management and Budget (OMB) received June 26 a Centers for Medicare & Medicaid Services (CMS) proposed rule regarding the Medicare Shared Savings Program (MSSP). This second round of rulemaking on the program is anticipated to address changes related to how Medicare pays participating providers. The MSSP intends to facilitate coordination and cooperation among providers to improve the quality of care for Medicare fee-for-service beneficiaries and reduce unnecessary costs through their participation in accountable care organizations (ACOs). Participating ACOs have saved Medicare hundreds of millions of dollars, however most ACOs have not met thresholds to receive bonuses.

Currently, participants have multiple payment options, including a two-sided risk model that incorporates penalties for failing to meet certain thresholds. However, a survey conducted by the National Association of ACOs found that two-thirds of ACOs would not participate under a risk model where penalties would be mandated. While it remains to be seen whether the proposed rule will make this type of determination, it will apply to existing ACOs and approved ACO applicants participating in the program starting 2016.

Please contact Xiaoyi Huang, JD, director of policy, at xhuang@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Matt Buechner is the policy and advocacy associate for America's Essential Hospitals.