ACOs vulnerable to penalties, no savings in light of coronavirus

Accountable care organizations that participate in the Medicare Shared Savings Program are concerned they will be on the hook for penalties and won’t receive shared savings this performance year because of the novel coronavirus.

The National Association of ACOs has been hearing from members worried the COVID-19 outbreak will drive up Medicare beneficiary spending this year, ultimately affecting the benchmark used to determine savings and losses in the program. The benchmark uses historical Medicare spending in addition to current performance year spending.

“It’s mixing apples and oranges,” said NAACOs Senior Vice President of Government Affairs Allison Brennan.

ACOs are accountable for Medicare beneficiaries who are particularly vulnerable to the coronavirus. The elderly and those with chronic conditions such as diabetes are most at-risk for serious side effects, according to the Centers for Disease Control and Prevention. As a result, ACOs can see spikes in expensive hospital stays and potential readmissions among their assigned Medicare beneficiaries. At the same time, spending will continue to be compared to previous years, which “is a big concern,” Brennan said.

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