Main Library
Over the last few years, the excitement over value-based care had decreased, if not vanished. Growth in MSSP was steady but unspectacular. ACO REACH was an interesting experiment with no clear path forward. Specialists stayed mostly outside the tent. In conference rooms, the former golden child “value-based care” was dismissed as a has-been.
The CY2027 Physician Fee Schedule — the annual proposed rule in which the Centers for Medicare & Medicaid Services (CMS) sets Medicare payment policy for physician and other billed services for the coming calendar year, including updates to accountable care organization (ACO) programs such as the Medicare Shared Savings Program (MSSP) — says not so fast.
In this blog, we analyze the contents, contemplate what it means for the industry’s future, and explain why it matters.
CMS just turned up the volume on value-based care
Buried in a sprawling physician-payment rule is a consistent signal: CMS wants more providers participating in accountable care arrangements, more beneficiaries assigned to them, and a greater share of Medicare spending governed by value-based incentives. The agency is proposing a benchmark adjustment that would reward qualifying ACO growth, assignment changes that could bring hundreds of thousands of additional beneficiary person-years into MSSP, and a new visit complexity modifier valued twice as highly for qualifying MSSP and LEAD participants as the modifier available outside those arrangements. None of these proposals are final, but together they make participation in accountable care materially more attractive.
Here is a rundown of what is in the proposed rule: