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FAH Comments on MSSP, ACO Pathways to Success Proposed Rule

October 17, 2018 | FAH Policy Blog team

Category: Financing, Medicare

FAH Comments on MSSP, ACO Pathways to Success Proposed Rule

FAH submitted comments Tuesday to CMS’ Medicare Shared Savings Program (MSSP); Accountable Care Organizations (ACOs) ― Pathways to Success Proposed Rule.

FAH said in the letter that it appreciates the agency’s efforts to improve the MSSP, but expressed concern that a number of aspects of the proposed rule could undermine the ability of ACO participants to achieve long term success in the program.

One of the main areas addressed in the letter is the FAH’s strong opposition to the low and high revenue distinction for determining participation options.

CMS proposes to define participation options by making a distinction between low revenue ACOs (proxy for physician group ACOs) and high revenue ACOs (typically associated with hospital ACOs). 

The FAH believes that this proposed policy would severely limit participation options for high revenue ACOs.

The letter states, “This low/high revenue distinction serves no purpose, other than punitive, given the steep structure of the glide path CMS proposes that would sharply limit time in the one-sided risk model options. This arbitrary distinction also discourages participation by the type of ACOs CMS most wants to attract; those, we believe, that can best coordinate acute and ambulatory care and are more likely to generate substantial savings to the Medicare program over the long-term.”

FAH also outlines several additional topical areas that CMS needs to address, including:

  • Revising definitions of experience and inexperience with Medicare ACO initiatives
  • Providing adequate and timely data
  • Using regional factors when establishing and resetting ACO’s benchmarks
  • Monitoring for financial performance
  • Supporting consistent data-sharing transparency for beneficiaries
  • Improving the processes for voluntary alignment
  • Incorporating stability and/or flexibility where appropriate, and
  • Addressing interactions between the MSSP and other CMS models

For more information on each issue – you can find the complete letter here.