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CMS Proposes Major Overhaul to Medicare Shared Savings Program ACOs, Accelerates the Pace for ACOs to Take on Downside Risk

This week, CMS released a proposed rule for the Medicare Shared Savings Program (MSSP), which includes most Accountable Care Organizations (ACOs). Currently, it includes several “tracks” of ACOs, with the lowest level, Track 1, not subjecting participants to any penalties if the ACO does not meet quality or cost metrics, but still allowing participants to receive bonuses if the ACO saves money. Most MSSP ACOs are Track 1, and most ophthalmologists that participate in ACOs are in Track 1. Citing the failure of most ACOs to move to higher tracks that incorporate the risk of penalties, CMS is proposing a new program, “Pathways to Success,” designed to spur existing ACOs to move to higher tracks or leave the program.

Under this proposal, beginning in July 2019, CMS would create two tracks, basic and enhanced. New ACOs would begin in the basic track and not have to bear risk for two years, as opposed to the current six-year period allowed before taking on risk. Current Track 1 ACOs would have one year to move to the enhanced, risk-bearing track.

Organizations that represent ACOs and hospitals were quick to criticize this proposed rule, and predicted many ACOs would leave the program, and it would have a chilling effect on creating new ACOs. CMS also released a press release along with the proposed rule. We will keep you updated.