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In a previous post, we examined how accountable care organizations (ACOs) would be impacted by a policy requiring a move to two-sided risk after the expiration of their current three-year term, along with the arguments for allowing ACOs to remain in one-sided risk in the Medicare Shared Savings Program (MSSP). In this, the second in our two-part series, we examine the arguments for requiring providers to transition from one-sided to two-sided risk in MSSP after their first or second three-year performance cycle. We close by offering a potential policy path forward.
CMS’ Original Intent For The Program
The Centers for Medicare & Medicaid Services (CMS) has already relaxed risk-bearing requirements for MSSP participants on multiple occasions. In the initial MSSP proposed rule issued in 2011,Track 1 ACOs would be required to assume two-sided risk in the third year of the first agreement period; however, following significant opposition in the stakeholder comments, CMS backed off that proposal to simply “require all ACOs to participate in the two-sided model in agreement periods subsequent to the initial agreement period.” CMS decided in its 2015 MSSP final rule to permit ACOs to remain in Track 1 for a second agreement period. Although additional flexibility may be warranted to ease the continued transition to downside financial risk, it is unclear how much time is objectively “enough” time for organizations to be ready.