NAACOS Urges CMS to Reconsider Policies That Negatively Impact ACOs

WASHINGTON - The National Association of ACOs (NAACOS) has released a white paper entitled, ACOs at a Crossroads: Cost, Risk and MACRA. The document calls attention to significant challenges facing accountable care organizations (ACOs), including recent policy decisions by the Obama Administration that significantly undercut the ability of ACOs to operate and flourish.

The white paper highlights how the current options for ACOs to take on further risk are too aggressive for the average ACO, requiring the participating physicians to risk their entire Medicare income in just the first year of the lowest risk (two-sided) track. It also documents the substantial financial risk every ACO now takes with supporting the operations of care coordination and information technology. These factors help explain why the shared savings only model (one-sided) of ACOs has grown 261 percent in four years while the two-sided, higher risk models, have grown only 62 percent, adding on average five organizations a year. It also points out that under MACRA (Medicare Access and CHIP Reauthorization Act), the Centers for Medicare and Medicaid Services (CMS) has proposed to exclude the lesser risk-taking, one-sided ACOs from the physician bonus program and how that will lead to significant decline in the total number of ACOs we have today.

ACOs represent a refined approach to the delivery of health care and were created to facilitate coordination and cooperation among providers.

"ACOs are extremely concerned about the direction the CMS is going not only in the proposed MACRA rules but also with the conflicts created by its other value-based payment programs such as bundled payment. And when you add that to how much it costs to run an ACO, there's a significant number of ACOs ready to leave the [Medicare Shared Savings Program, MSSP] program," said Clif Gaus, President and CEO of NAACOS.

Addressing these challenges will not be easy but is essential to securing the foundation of Medicare ACOs. NAACOS urges CMS and the Administration to take immediate action to:

Account for the significant investments ACOs make by including them in calculations of ACO risk, Address shortcomings of existing ACO two-sided risk models which require levels of financial risk that are untenable for many ACOs, Include all ACOs in CMS's list of Advanced Alternative Payment Models (APMs) under MACRA, and Remedy issues related to the overlap of competing CMS programs in a way that prioritizes population-based payment models such as ACOs.

"ACOs at a Crossroads" and its recommendations follow a recent NAACOS ACO Cost and MACRA Implementation Survey from 144 unique MSSP ACOs that found that over half (56 percent) were unlikely to stay in the MSSP if not eligible for the Advanced APM bonus.

"Our survey shows how ACOs are growing in their frustration as new policies come out that exclude or negatively impact ACOs. We hope that CMS and the Administration will listen to these important stakeholders. The ACOs' frustration is understandable," said Clif Gaus.

NAACOS desires to see Medicare ACOs achieve long-term sustainability necessary to enhance care coordination for beneficiaries, lower the growth rate of health care spending, and improve quality in the Medicare program. ACOs are on the cusp of so much potential, and NAACOS hopes that "ACOs at a Crossroads" will initiate a dialogue about these issues so we can work together to support ACOs today and moving into the future.

More information about "ACOs at the Crossroads: Cost, Risk and MACRA" can be found at www.NAACOS.com.

About NAACOS.

The National Association of ACOs (NAACOS) is the largest association of Medicare ACOs, representing over 3 million beneficiary lives through 180 MSSP ACOs, Next Generation, Pioneer and commercial ACOs. NAACOS is an ACO member-led and member-owned non-profit organization that works on behalf of ACOs across the nation to improve the quality of Medicare delivery, population health and outcomes, and healthcare cost and efficiency.