CMS issued a proposed rule Aug. 9 that would make sweeping changes to the Medicare Shared Savings Program, including overhauling the way ACOs share in risks and rewards. Here are seven things to know about the proposed rule: 1. The redesigned program — which CMS has dubbed “Pathways to Success” — would expand ACO participation…
On August 9, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would set a new direction for the Medicare Shared Savings Program (Shared Savings Program). Referred to as “Pathways to Success,” this proposed new direction for the Shared Savings Program would redesign the participation options available under the program…
The CMS wants to eliminate zero and low-risk tracks for accountable care organizations to more quickly move them to downside risk. The agency announced Thursday that it is planning to overhaul the Medicare Shared Savings Program by scrapping Track 1 and Track 2 and will launch a Basic track that provides a smaller window for…
Roughly 20 percent of the United States population lives in rural areas. Despite this, rural America faces a number of health-related challenges, some of which are structural, while some are related to regional differences in health and health care in this country. Compounding these issues, incomes are lower and poverty rates are higher in many…
Medicare accountable care organizations (ACOs) operating under two-sided financial risk arrangements save the federal healthcare program more than one-sided risk organizations. But policymakers must address financial incentives, benchmarks, and other issues to ensure two-sided risk ACOs continue to generate savings, the Medicare Payment Advisory Commission (MedPAC) recently reported. “Medicare ACOs were created to help moderate…
There are now more than 335 Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) in 47 states, DC, and Puerto Rico. Early results show that most Medicare ACOs are succeeding at meeting their quality benchmarks, but only about a quarter of MSSP participants have been able to reduce their spending enough…
Moving accountable care organizations (ACOs) to Medicare Shared Savings Program (MSSP) tracks with downside financial risk may not help the accountable care initiative generate savings, according to a new analysis from the Center for Healthcare Quality and Payment Reform (CHQPR). The study found that CMS spends more per beneficiary in ACOs with downside risk compared…
An Accountable Care Organization (ACO) is a voluntary coalition of healthcare providers characterized by a care delivery and reimbursement model tying provider payments to quality metrics and patient care outcomes. The goal of the ACO model is to reduce total care costs for a specific patient population. Each ACO has a defined patient population for…
As the healthcare industry continues the march toward value-based care, CMS has turned a critical eye on one-sided ACO contracts for driving up costs and making little progress toward value. “These ACOs are actually increasing Medicare spending, and the presence of these ‘upside-only’ tracks may be encouraging consolidation in the marketplace, reducing competition and choice…
Ann Morse Abdella was all in when the Medicare Shared Savings Program started in 2012. She helped launch a rural accountable care organization in western New York, serving roughly 7,000 Medicare beneficiaries. Six turbulent years later, Chautauqua Region Associated Medical Partners is heading for the exit. The constantly evolving program and its increasing pressure to…