Healthcare Intelligence Network

More than half—56 percent—of accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) indicated they would leave the MSSP program if their ACOs were not eligible for the 5 percent Advanced Alternative Payment Model (APM) bonus under MACRA, according to a May 2016 survey by the National Association of ACOs (NAACOS).

A third of ACOs said they would stay in the MSSP program even if deemed ineligible for the bonus, the NAACOS survey found.

The Alternative Payment Model is one of two paths for participation in the quality improvement programs included in the MACRA legislation for eligible professionals; the other is the Merit-Based Incentive Payment System (MIPS).

Currently, MSSP Track 1, a one-sided payment model, is not among the models that would qualify for the APM track—which CMS calls “Advanced APMs”—under the proposed MACRA rule; however, the MSSP Tracks 2 and 3, Next Generation, and Pioneer ACO programs, which all require downside risk, would qualify as APMs.

Approximately 411 MSSP ACOs, or 95 percent, participate in Track 1 of the program, according to April 2016 data from CMS.

All APM qualifying participants will receive a 5 percent lump sum bonus on their Medicare payments for 2019 through 2024. This bonus will be in addition to the incentive paid through existing contracts with the qualified APM (e.g., MSSP) demonstration program, etc.

Beginning in 2026, these ACOs will qualify for a 0.75 percent increase in their payments each year.

In other findings, the NAACOS survey also determined the following:

• More than half of respondents (51 percent) describe their ongoing ACO operational costs as very significant;
• The average total ACO operating costs for all respondents is $1.6 million per year, but the cost difference is significant between single or multi-ACOs, with single ACOs averaging just under $2 million and multi-ACOs averaging almost $1 million per year.
• If required by CMS to take on downside risk, 43 percent said they would leave the MSSP program and about a third would stay (33 percent).
• Over three quarters of the ACO respondents (84 percent) said they would be ready for downside risk within the next six years, with 44 percent of those even ready as soon as one to three years.

Tags: Advanced Payment Models, APM, Medicare Shared Savings Program, Merit-Based Incentive Payment System, MIPS, MSSP

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This entry was posted on Thursday, June 2nd, 2016 at 12:10 pm and is filed under Accountable Care Organizations, Affordable Care Act, MACRA, Value-Based Reimbursement. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.