Medicare Urged to Provide More Virus Help for Care Networks (1)

Nine leading health-care organizations are asking the Trump administration to provide additional pandemic-related support for groups of doctors and hospitals that provide coordinated care in traditional Medicare.

The 517 provider groups, known as accountable care organizations, are helping traditional Medicare move from a fee-for-service payment model to value-based care, in which provider reimbursement is based on patient outcomes rather than volume of services.

When ACOs improve beneficiary health and lower costs for the Medicare program, they share in the savings. But 192 ACOs take “downside” financial risk for cost increases, meaning they could also lose revenue and be required to reimburse Medicare if their cost of care exceeds agreed-upon thresholds.

Nearly 30% of Medicare fee-for-service beneficiaries—about 11.2 million people—are now served by providers in ACOs. That’s up from 10.4 million at the beginning of 2019.

The Centers for Medicare & Medicaid Services announced, in an interim final rule issued April 30 that ACOs’ Covid-19-related care costs during the pandemic health emergency will not count toward those thresholds.

But in a letter Thursday to CMS Administrator Seema Verma, the National Association of Accountable Care Organizations and eight other caregiver organizations said more help is needed to keep ACOs afloat in the Medicare Shared Savings Program—traditional Medicare’s leading value-based care initiative.

They want Verma to:

• allow ACOs to be fully protected from losses in exchange for them receiving a reduced share—no less than 40%—of the savings they achieve for the program.
• extend the June 1 deadline to voluntarily terminate participation in the Shared Savings Program to Oct. 31 at the earliest;
• reverse the cancellation of the 2021 Shared Savings Program application cycle; and
• as soon as possible, pay ACO shared savings payments and advanced alternative payment model bonuses.

“We appreciate CMS protecting shared savings opportunities for ACOs while working to mitigate the negative effects of COVID-19 on ACOs,” Clif Gaus, NAACOS president and CEO, said in a statement.

“However, there is still a tremendous amount of uncertainty surrounding the pandemic, including when the public health emergency and the protections and support it offers will end,” Gaus said. “Providing more time for ACOs to determine if they can stay in the program is critical for alleviating concerns about shouldering liability for a global pandemic.”

The other groups are the American Academy of Family Physicians, the American College of Physicians, the American Medical Association, the American Medical Group Association, America’s Physician Groups, the Association of American Medical Colleges, the Medical Group Management Association, and the Premier health-care alliance.

A CMS spokesperson said the agency “has received a number of letters on the coronavirus disease 2019 (COVID-19), and we are working to respond. We continue to maintain an open line of communication with the National Association of Accountable Care Organizations and the physician groups, while helping coordinate the response to the public health emergency.”