New Medicare Shared Savings Program Proposed Rule for Accountable Care Organizations

The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule, which would institute a number of major changes to the Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs). The proposed rule, which creates a redesigned program titled “Pathways to Success,” changes the overall structure of the MSSP, and requires ACOs to assume more risk than they are required to under the current MSSP.

Under the current MSSP, ACOs have three different participation tracks in which an ACO can choose to participate. In Track 1, ACOs can receive reimbursement of up to 50% of savings under the benchmark, and are not required to share in costs if spending exceeds the benchmark. In other words, the ACO does not have to share in any downside risk under Track 1. Under Tracks 2 and 3, an ACO is eligible to receive a greater percentage of cost savings, but must also bear downside risk by sharing losses with CMS if ACO spending is above the benchmark.

Comparatively, under the proposed rule, ACOs would be limited in the amount of time that can be spent in a one-sided risk model. ACOs that are new to the MSSP can remain in a one-sided risk model for a maximum of two years, while ACOs that are already participating in the MSSP can only remain in a one-sided risk model for one year. The proposed rule also aims to provide greater flexibility for ACOs as well as to promote beneficiary involvement.

If finalized in its current form, the proposed rule would institute major changes for ACOs as the providers in the ACO would assume greater risk and accountability when participating in the MSSP. Frier Levitt will continue to monitor the proposed rule as CMS moves to formulate a final rule, which will shape the MSSP’s future. Contact Frier Levitt to learn more about the MSSP and benefits to participating in an ACO.