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CMS Proposes Changes to MSSP

The Centers for Medicare & Medicaid Services (CMS) released Dec. 1 the Medicare Shared Savings Program (MSSP) proposed rule, which focuses on accountable care organizations (ACOs). The MSSP aims to facilitate coordination and cooperation among providers to improve the quality of care for Medicare fee-for-service beneficiaries and reduce growth in health care costs. Eligible providers participate in this program by creating or joining ACOs, through which they can share savings with Medicare when they demonstrate efficient care delivery and meet quality performance benchmarks.

In the rule, CMS proposes to provide flexibility to ACOs that seek to renew their participation in the program. CMS proposes to do that by allowing ACOs that have entered the program under a one-sided risk model, where the ACO shares in savings but does not assume additional performance-based risk, to renew their program agreement under the one-sided model for an additional agreement period. Currently, the agreement period is three years. CMS is also soliciting comments on how to make the two-sided risk model, where the ACO assumes greater share of financial losses but is rewarded with a higher share of savings, more attractive to MSSP participants. Further, CMS proposes to add an additional risk model, which the agency refers to as track 3. This new track would offer ACOs a higher shared savings rate and prospective assignment of beneficiaries.

CMS also proposes to refine how Medicare beneficiaries are assigned to ACOs to emphasize the role of primary care and allow for certain, non-primary care specialists to participate in multiple ACOs. Lastly, CMS is soliciting feedback on alternative methodologies for developing the benchmarks used to determine shared savings and losses.

The proposed rule will be published in the Federal Register Dec. 8, and comments are due to CMS by Feb. 6. Please contact Xiaoyi Huang, director of policy, at xhuang@essentialhospitals.org or 202.585.0127 with any questions.

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About the Author

Gontscharow is a senior policy analyst for America's Essential Hospitals.