Skip to main content

ACOs must act now to get ahead of MSSP changes



Redesigned MSSP program

The Medicare Shared Savings Program, one of Medicare’s largest alternative payment models, allows providers and suppliers the opportunity to form an Accountable Care Organization. It was redesigned in 2018, establishing “Pathways to Success” as a way to restructure participation and encourage ACOs to transition to two-sided risk models. 

As part of this rule, a BASIC track was established for ACOs to begin participation under an upside-only risk model and to incrementally phase into a two-sided risk model through a glide path. The glide path is composed of Levels A through E, in which there is progressively greater financial risk and potential opportunity for savings. 

It is critically important for ACOs to understand how their level of participation in MSSP will change in the coming years.

COVID-19 impact on MSSP advancement

The COVID-19 public health emergency has disrupted efforts to improve population health and care coordination, and has resulted in a lack of predictability within ACOs in relation to service utilization, beneficiary assignment and cost sharing.

Provisions in the FY 2022 Medicare Hospital IPPS and LTCH Rates Proposed Rule would allow ACOs to elect to remain in the same level of the glide path for performance year 2022 if the effects of the PHE continue to be felt.

ACOs that elect to maintain their level in the glide path during performance year 2021 and/or PY 2022, due to the PHE, would automatically transition to the level of risk they would have been in for PY 2023. 

Key considerations for ACOs

The good news for ACOs is that CMS has recognized that the PHE will likely impact patient care patterns into 2022. As ACOs are feeling more risk-averse, continued flexibility in their participation is needed to keep them in the MSSP program. 

However, ACOs that maintain a low risk level during the PHE would need to prepare to face a much higher level of risk when PY 2023 begins. For example, an ACO at Level A for PY 2020 whose level of participation was maintained for PY 2021 and 2022 would enter PY 2023 at Level D, which is a higher level of risk. Level D participation would increase the shared savings rate from 40% to 50% and shared losses rate from 0% to 30%. 

ACOs must prepare for the impact these changes may have on their organizations, whether they decide to maintain their current participation level or advance along the glide path for the next year. 

Connect with DataGen to assess the financial implications of MSSP changes for your organization and to make more informed decisions for future success.

Comments

Popular posts from this blog

How to prepare: Radiation Oncology Model, Part 1

Check your participation status and build your plan Are you a hospital outpatient department, physician group practice or freestanding clinic providing radiation therapy services? If so, you may be required to adopt the new mandatory Radiation Oncology Model. Mandatory participation is randomized by Core-based Statistical Areas. You can check your organization’s participation status online. CMS released the Final Rule for the RO Model, giving providers 60 days to prepare for program launch on January 1, 2022. If your organization performs radiation therapy in a ZIP code on the list, you will need to begin preparing for the model.

Proposed rule updates for the Radiation Oncology Model

The new Radiation Oncology alternative payment model will start Jan. 1, 2022, after the proposal is finalized in the calendar year 2022 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System final rule, scheduled for early November. This rule will require prospective hospital outpatient departments, physician practices and freestanding clinics providing radiation therapy services to adopt a prospective bundled payment model with new clinical and quality measure reporting requirements. The model is mandatory for participants selected by CMS. The new RO model includes several notable changes that must be addressed for successful participation: Disease sites update The criteria for cancer types have been clarified. Cancer types must be: commonly treated with radiation therapy according to nationally recognized evidence-based guidelines; associated with ICD-10 codes that demonstrate pricing stability; and not determined to be unsuitable for inclusion by the H

What to know about CMS’ 2022 rules

Key takeaways from five final and two proposed rules from CMS CMS adopted five final Medicare Prospective Payment System rules for FFY 2022 and proposed two rules for calendar year 2022. DataGen has interpreted and analyzed each of the final and proposed rules to help you gauge how these changes may impact your organization.   These rules include regular updates to the wage index and other significant items listed below. The Inpatient PPS final rule includes the following proposals: rebasing and revising the IPPS marketbasket and the Capital Input Price Index from FFY 2014 cost report data to FFY 2018 data; rate increase (+0.5%) for the Medicare Access and CHIP Reauthorization Act of 2015 coding offset adjustment; nonstandard adjustments to hospital wage indexes (for eligible hospitals) including bottom quartile adjustments, a 5% wage index “stop-loss” and the reintroduction of an imputed floor policy as mandated by the Consolidated Appropriations Act of 2021; updates to Medicare Dis