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

BPCI Advanced – take advantage of the model extension now

The Bundled Payment for Care Improvement (BPCI) Advanced Model is now open for applications until May 31, 2023. This model provides a unique opportunity to acute care hospitals and physician group practices who are looking to: evaluate their bundle performance; rejoin if they have previously dropped out due to being under a convener; or take advantage of the changes to the model. With a small window to sign the participation agreement, you’ll need experts to process data quickly and accurately for evaluation. BPCI Advanced Program Details The Centers for Medicare & Medicaid Services (CMS) announced in October 2022 that this program will extend from January 2024 to December 2025. Data used for evaluation will be taken from the baseline period between October 2018 and September 2022. A participation agreement will be sent out in September 2023 and needs to be signed by October 2023 in order to participate. Those who apply before the May 31 deadline will benefit

BPCI Advanced Model Extension

CMS recently made several major announcements about the Bundled Payments for Care Improvement Advanced Model. The model, which was due to expire at the end of 2023 (Model Year 6), will be extended for an additional two years through Dec. 31, 2025. New applications will be accepted in 2023 for the two-year extension. Participants still active in Model Year 6 can continue without reapplying by signing an amended and restated participation agreement for Model Year 7. New methodological changes will be implemented for Model Year 6, which starts on Jan. 1, 2023. Methodological changes include that: the CMS Discount Factor for medical clinical episodes will be reduced from 3% to 2%; the Peer Group Trend Factor Adjustment cap for all clinical episodes will be reduced from 10% to 5%; the Major Joint Replacement of the Upper Extremity clinical episode category will become a multi-setting episode category by allowing episodes to be triggered when the procedure is performed in the hospital ou

You’ve been accepted to the Enhancing Oncology Model. Now what?

The Centers for Medicare and Medicaid Services Innovation Center recently announced approved applicants for the new Enhancing Oncology Model. If your facility has been selected by CMS, are you still weighing your options during the current baseline evaluation period? Two deciding factors may include the program data that CMS provides and whether EOM is enough of an improvement over the prior Oncology Care Model to make your investment worthwhile. Another factor to consider: Will you have the resources in place to conduct a baseline evaluation before EOM’s program start on July 1, 2023? How EOM differs from OCM EOM aims to improve the coordination of oncology care, drive practice transformation and reduce Medicare fee-for-service spending through episode-based payment. It includes three major updates: Fewer cancer types. Compared with OCM’s 21, EOM will be limited to seven common cancer types: breast, prostate, lung, small intestine/colorectal, multiple myeloma, lymphoma and chronic le

DataGen

Search This Blog