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The prognosis of COVID-19 on the US health care system may include yet another devastating outcome: delaying its transition to value-based care. The Centers for Medicare and Medicaid Services (CMS) has stopped accepting applications for new accountable care organizations (ACOs) in 2021. Furthermore, it has amended quality reporting requirements for ACOs, reduced their downside risk, and excluded costs attributed to COVID-19 from shared savings calculations. These actions justifiably alleviate some pressure from hospitals dealing with COVID-19. But if these changes continue indefinitely alongside this pandemic, the consequences may be dire.
Let’s be clear: CMS’s actions are rooted in good intentions and seek to protect existing ACOs. According to the National Association of ACOs’ April survey of 226 ACOs nationwide, nearly 60 percent are likely to leave the Medicare Shared Savings Program (MSSP) over concerns about repaying losses in 2020 because of COVID-19. But these numbers do not mean value-based care is unworkable…