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Provider Groups Ask Medicare to Shield Them From Covid-19 Losses

March 17, 2020, 6:20 PM

The groups of doctors, hospitals, and other clinicians that provide coordinated care for Medicare beneficiaries are urging program administrators to ensure they aren’t held responsible for increased costs related to the new coronavirus pandemic.

The nation’s 517 provider groups, known as accountable care organizations (ACOs), are a vital component of traditional Medicare’s move from a fee-for-service payment model to value-based care, in which provider reimbursement is based on patient outcomes rather than the volume of services provided.

When ACOs improve health and lower costs for the Medicare program, they share in the savings. But some ACOs could lose revenue and have to reimburse Medicare if their cost of care exceeds agreed-upon thresholds.

The National Association of Accountable Care Organizations, in an email on Monday, asked the Centers for Medicare & Medicaid Services to exclude spending for Covid-19 patients from ACO expenditures that count toward those thresholds.

“While ACOs are focused on treating patients, we are reaching out to you on their behalf to ensure COVID-19 does not derail the ACO and value movement, which could easily happen if steps aren’t taken by CMS,” association president and CEO Clif Gaus said in the email to CMS Administrator Seema Verma.

The association also asked the agency to extend deadlines for submitting quality reporting data and applying to certain payment models.

With older Americans more susceptible to the Covid-19 infection, the association said it expects spending on Medicare beneficiaries to spike.

Nearly 30 percent 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 CMS did not immediately respond to a request for comment.

To contact the reporter on this story: Tony Pugh in Washington at tpugh@bloomberglaw.com

To contact the editors responsible for this story: Fawn Johnson at fjohnson@bloomberglaw.com; Alexis Kramer at akramer@bloomberglaw.com

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