Following is an excerpt:
Medicare accountable care organizations (ACOs) are likely to face an imminent overhaul, according to former leaders of the program. …
Leslie V. Norwalk, strategic counsel with Epstein Becker Green and formerly acting administrator of CMS for President George W. Bush, said ACOs have helped improved quality, “but the outlays are higher.”
“I suspect CMS will say, ‘If you’re going to take upside [risk], you’re going to downside,” Norwalk said in an interview.
New limitations on Medicare Shared Savings Program (MSSP) Track 1 ACOs, which are eligible for bonus payments but not penalties, would mark a major shift for that dominant class of payment models. Track 1 ACOs constitute 82 percent of all Medicare ACOs. Seema Verma, administrator of CMS, recently delivered critical remarks about Track 1 ACOs in an address to hospital leaders, and CMS is preparing to release a proposed rule that may include big changes for the program.
Among likely changes are rules that allow larger upside and downside risk, more data sharing, and changes to the quality metrics, Norwalk said.
The appointment in April of Adam Boehler, a former CEO of home healthcare service provider Landmark Health, as director of the Center for Medicare and Medicaid Innovation (CMMI), was important as a sign of the administration’s priorities, Norwalk said.
“You’re looking at a much more open approach to innovation and sharing risk,” Norwalk said.