PwC: CMS proposed rule would extend shared savings model for ACOs

WASHINGTON — The Centers for Medicare and Medicaid Services issued a proposed 428-page rule change earlier this week that would offer health systems more flexibility regarding the agency's accountable care program, PricewaterhouseCoopers' Health Research Institute noted Friday. Under the proposed rule, "ACOs may participate in a shared savings model past the three-year window without risking financial losses," the institute reported. "CMS also proposed creating a new ACO track that allows providers to capture more savings, while also giving them greater access to patient health data."

 

It's mixed news for the current 330 ACOs in existence, noted the National Association of ACOs. "NAACOS has numerous times pointed out that the current balance between risks and rewards is not a sustainable business model for the long-term," the association stated in a release Monday. "ACOs have demonstrated in the first 20 months of the program a uniform and substantial improvement in the quality of care for Medicare beneficiaries. Medical Groups and Hospitals have accomplished this with a large investment of their own capital and operating funds totaling almost a $1 billion to date," the association added. "ACOs have received in return for that investment less than 25%, and three-fourths of the ACOs have received no financial return for their investment."

 

More than 100 ACOs have stated that they will not stay with the program for the next contract term if there is not an improvement in the program, NAACOS noted. 

 

"The proposed rule underscores that the concept of accountable care is here to stay, even if it requires fine-tuning," HRI commented. "Most providers have been hesitant to take on financial risk under some ACO models, relying instead on a largely fee-for-service payment system. But CMS remains optimistic, citing reduced costs from those providers currently participating in the ACO programs. Getting to that point, however, is challenging. Providers need to fully understand their current payer and patient mix before they move to a model in which they are at risk for financial losses," HRI continued. "Providers that achieve some savings often reinvest the money back into building an ACO infrastructure, which can include new technology that helps physicians better understand their patient population through data analytics."

 

"Efforts to revamp the delivery of care will require more time as ACOs build new relationships, new infrastructure and learn and adapt early redesign efforts," Clif Gaus, NAACOS CEO, told HRI. "It's probably a decade-long process to redesign all of the care processes that lead to both better care and more appropriate care."