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PALM DESERT CA, USA -- HEALTHCARE UPDATE NEWS SERVICE™ -- JUNE 10, 2015: CAPG, the leading U.S. trade association for physician organizations practicing capitated, coordinated care, commended the Centers for Medicare & Medicaid Services’ (CMS) Final Rule implementing key changes to the Medicare Shared Savings Program (MSSP).
The Final Rule, released June 4, strikes an important balance as CMS encourages accountable care organizations (ACOs) to continue on the path toward performance-based risk and ultimately capitation. The rule takes critical steps to respond to the ACO community’s concerns about the MSSP, making improvements to data sharing and beneficiary assignment, along with modest improvements to benchmarking challenges.
"CAPG has long called on CMS to offer additional payment options for organizations that desire higher levels of risk," noted CAPG President and CEO Donald H. Crane. "We believe that this Final Rule, taken together with the newly announced Next Generation ACO program out of the Innovation Center, provide a stronger path forward for accountable, coordinated care in Traditional Medicare.
"The Next Generation ACO goes even further, offering a capitated payment model and additional financial incentives for beneficiaries that receive most of their care from ACO providers."
In an earlier comment letter, CAPG had encouraged CMS’s view of the ACO program as an onramp to risk. CAPG requested that the agency pay attention to both ends of that ramp—the entrance and the destination—by encouraging one-sided ACOs to stay in the program and also building very strong incentives to guide ACOs into risk-bearing arrangements.
In the Final Rule, CMS strikes an important balance in moving ACOs from upside-only payment models (in which ACOs share in savings but are not accountable for financial losses) to two-sided risk arrangements (ACOs share in both savings and losses). In the Final Rule, CMS will allow ACOs to remain in Track One, upside-only risk, for an additional three-year contract cycle.
At the same time, CMS is finalizing a new Track 3, performance-based risk-bearing track with additional features that experienced ACOs had requested. As an example, CMS will waive certain fee-for-service regulations related to skilled nursing facility coverage for ACOs that take on downside financial risk. CMS is also making available prospective beneficiary alignment for Track 3 ACOs. And finally, CMS is making available the option of first dollar savings and losses for risk-bearing ACOs.
CAPG continues to work with Congress and CMS to encourage the broader availability of capitated, high quality delivery models in Traditional Medicare. The association will be providing analysis of the Final Rule to its members.
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CAPG is the nation’s leading trade association representing physician organizations delivering capitated, clinically integrated health services. The organization’s approximately 190 member groups employ and/or contract with physicians who provide healthcare services to millions of patients in 38 states, the District of Columbia, and Puerto Rico. CAPG members are committed to providing high quality, affordable healthcare. To learn more, visit capg.org and @CAPGVoice.
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