CMS Proposes Fundamental Changes to the Medicare Shared Savings Accountable Care Organization Program

Patient appointment with doctor

On Thursday, August 9, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule focused on revamping the Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) Program.

Renaming the program as “Pathways to Success,” CMS is proposing to push more program participants to join two-sided risk models – in which they may share in savings and are accountable for repaying shared losses – rather than remain in models under which eligible ACOs receive a share of any savings under their benchmark but are not required to pay back a share of spending over the benchmark.

In addition, CMS is proposing to expand the use of telehealth for certain providers that are in these two-sided risk models. Beginning in 2020, some ACO providers would be eligible to receive payment for telehealth services furnished to certain beneficiaries even if the otherwise applicable telehealth geographic limitations are not met, including when the beneficiary’s home is the originating site.

CMS is also proposing to better align the certified electronic health record technology (CEHRT) requirements for MSSP with the Quality Payment Program. Beginning in 2019, CMS wants all ACOs that do not meet the financial risk standard to be an Advanced APM to certify that at least 50 percent of their eligible clinicians use CEHRT to document and communicate clinical care to their patients or other health care providers.

Moreover, to bolster beneficiary engagement, CMS is proposing to allow certain ACOs under performance-based risk models to provide incentive payments to patients for taking steps to achieve good health.

Look to HIMSS for more details on the new MSSP ACO proposed rule in the coming days.