Main Library
To provider organizations, the Change Healthcare hack in February was a painful reminder of a lesson learned during the first year of the COVID-19 pandemic: A disruption in revenue flow can lead to financial disaster or even closure.
Many smaller hospitals and medical offices have struggled to get paid since the ransomware attack shut down Change’s billing and payment system. Similarly, provider organizations that relied heavily or even solely on fee-for-service (FFS) in 2020, but, as a result of the COVID pandemic, could not treat patients and, therefore, not get paid.
Clearly, FFS has its flaws, which have given rise to alternative payment models such as value-based care (VBC), along with efforts by CMS to promote accountable care organizations (ACOs) that prioritize patient outcomes and cost controls over volume of service.
CMS recently introduced a new ACO model designed to ease the cost of setup for low-revenue ACOs focusing on primary care. The ACO Primary Care (PC) Flex Model will launch on New Year’s Day 2025.
The PC Flex Model will provide qualifying ACOs with one-time advanced Medicare Shared Savings Program (MSSP) payments of $250,000 intended to help providers with the costs of forming an ACO, as well as the ongoing administrative costs associated with program participation, CMS said in a news release.