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CMS Extends Savings-Only Risk Model for ACOs

The Centers for Medicare & Medicaid Services (CMS) released June 4 the Medicare Shared Savings Program (MSSP) final 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.

CMS finalized its proposal to provide flexibility to ACOs looking to renew their participation in the program. ACOs will have the option to extend participation for three years in the one-sided, savings only model (track 1), in which providers do not face penalties. ACOs may only operate under track 1 for a maximum of two, three-year agreement periods. CMS also finalized the creation of an additional double-sided risk model (track 3), which will offer ACOs a higher shared savings rate than the existing double-sided model (track 2) and a fixed number of beneficiaries, in addition to a higher share of potential losses.  

CMS also finalized a change in how Medicare beneficiaries are assigned to ACOs that emphasizes the role of primary care and allows for certain, non-primary care specialists to participate in multiple ACOs. CMS believes this revision will ensure the provider who is providing the plurality of primary care is ultimately responsible for managing the patient’s overall care. Finally, in the proposed rule, CMS solicited feedback on alternative methodologies for developing the benchmarks used to determine shared savings and losses. The agency notes that a supplementary proposed rule will be released later this summer that will modify the benchmark methodology.

The final rule will be published in the Federal Register June 9. Please contact Maryellen Guinan, Esq., policy analyst, at mguinan@essentialhospitals.org or 202.495.3354 with any questions.

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About the Author

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

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