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CMS Proposes Redesign of MSSP

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule with updates to the Medicare Shared Savings Program (MSSP) that would create a pathway for accountable care organizations (ACOs) to more rapidly transition to performance-based risk.

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 in this voluntary program create or join ACOs, through which they share savings with Medicare by demonstrating efficient care delivery and meeting quality performance benchmarks.

For ACOs applying to participate in the MSSP in 2019, CMS proposes restructuring participation options by:

  • discontinuing Track 1 (one-sided shared savings only model) and Track 2 (two-sided risk model with shared savings and losses);
  • maintaining Track 3 (two-sided model with highest risk) and renaming it the ENHANCED track; and
  • introducing a new BASIC track, offering a path from the one-sided risk model to incrementally phased-in risk and potential reward over the course of a single agreement (i.e., a glide path).

CMS proposes other changes in the redesign of the MSSP, including:

  • allowing agreement periods of at least five years, versus the current three-year agreement periods;
  • differentiating low-revenue versus high-revenue ACOs, based on degree of control over total Medicare Part A and B fee-for-service expenditures for assigned beneficiaries;
  • encouraging the development of physician-only and rural ACOs;
  • requiring high-revenue ACOs to enter the ENHANCED track after no more than one agreement period under the BASIC track;
  • changing program requirements on the use of certified electronic health record technology;
  • continuing to refine benchmarking methodology;
  • seeking feedback on ways to improve the quality measure set, in response to CMS’ Meaningful Measures Initiative, and including ways to address opioid use; and
  • seeking feedback on approaches to improve pharmacy care coordination for beneficiaries through collaboration between Medicare ACOs and sponsors of stand-alone Part D prescription drug plans.

CMS proposes a July 1, 2019, start date for the first agreement period under the proposed new participation options, to allow ACOs time to consider the new options and prepare for program changes.

America’s Essential Hospitals is analyzing the proposed rule for comment and will send members a detailed Action Update in the coming days. CMS is accepting comments on the proposed rule until Oct. 16.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Maryellen Guinan is a principal policy analyst at America's Essential Hospitals.

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