AMA and others make MSSP requests ahead of final rule

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Ahead of the September 6 comment deadline, the American Medical Association and 10 other provider organizations submitted comments to the Centers for Medicare and Medicaid Services on how the 2023 Medicare Physician Fee Schedule Proposed Rule affects accountable care organization models.

The rule, if finalized, would bring several positive changes to the Medicare Shared Savings Program, Medicare's largest value-based payment model, the organizations said in the September 1 letter to CMS Administrator Chiquita Brooks-LaSure.  

This includes giving ACOs more time before advancing to the highest levels of risk, providing fairer, more accurate financial benchmarks, positive changes to quality scoring approaches and providing advanced shared savings payments to smaller ACOs that serve underserved populations, the letter said.

However, the organizations want CMS to expand the types of ACOs that can receive advance investment payments being proposed in MSSP. Advanced payments should be available to all ACOs who are working to achieve health equity, the letter said.

WHY THIS MATTERS
  
The letter was signed by 10 organizations representing physicians and other stakeholders. They are America's Essential Hospitals, American Academy of Family Physicians, American Medical Association, AMGA, Association of American Medical Colleges, Federation of American Hospitals, Health Care Transformation Task Force, Medical Group Management Association, National Association of ACOs, National Rural Health Association, and Premier,

These organizations are requesting:

• A refocus on the high and low revenue distinctions of ACOs to address the characteristics of beneficiaries served by an ACO. ACOs that include certain providers such as safety net hospitals and rural health clinics generally won't benefit from the proposed changes to progression through risk, they said.
• To allow existing ACOs to opt in to proposed benchmarking and risk-adjustment policies. The vast majority of existing ACOs will not have access to these improved policies for several years, thus excluding them from their benefits, the letter said.
• Stakeholder engagement in designing future benchmarks. The groups said they applaud CMS for recognizing the need for a long-term solution to the benchmarking "ratchet effect" with administrative benchmarks, but the agency needs a robust dialogue with stakeholders to avoid any unintended consequences.
• A timeline reconsideration for ACO requirements on electronic quality reporting. While many of the proposed changes are a step in the right direction, more work is needed to ensure a smooth transition to electronic clinical quality measure reporting, they said.
• Support for an extension of the Advanced Alternative Payment Model (APM) bonuses. While it's ultimately up to Congress to extend the 5% incentive payments, CMS leadership could work with Capitol Hill to ensure adequate incentives for APMs, the letter said.
• Utilization of a MSSP innovation platform. CMS could leverage ACOs to test new concepts typically reserved for CMS Innovation Center models such as a full-risk track, primary care capitation and other public health emergency-era waivers, the organizations said.

THE LARGER TREND

CMS released the 2023 Medicare Physician Fee Schedule Proposed Rule in July, with comments due by September 6.

CMS said this week that the Medicare Shared Savings Program saved Medicare $1.6 billion in 2021.

Since 2012, ACOs have saved Medicare $13.3 billion in gross savings and $4.7 billion in net savings, according to NAACOS, the National Association of ACOs. ACOs care for nearly 20% of all Medicare patients and nearly a third of traditional Medicare patients. Importantly in Medicare, ACOs allow patients to maintain their choice of provider, and there are no network restrictions or use of prior authorization, NAACOS said.

ON THE RECORD

"We appreciate that many of the proposed changes in this rule are responsive to recommendations we have made for improving the MSSP," the letter states. "Ultimately, many of these proposals will help grow participation in ACOs and realize CMS's stated goal to have all Medicare beneficiaries in a relationship with a provider who is responsible for quality and total cost of care."

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org