|April 28, 2014|
Previously published on April 2014
On April 17, 2014, the American Hospital Association (“AHA”) published a letter to the Centers for Medicare & Medicaid Services (“CMS”) criticizing the current Pioneer Accountable Care Organization (“ACO”) Model and Medicare Shared Savings Program (“MSSP”).
In the letter, the AHA states that both programs “place too much risk and burden on providers with too little opportunity for reward in the form of shared savings” and sets forth a series of recommendations for improving the programs, including:
- extending the Track 1 agreement period;
- creating more achievable thresholds in the early years of the agreement;
- allowing Medicare beneficiaries to “opt in” to ACO programs; and
- simplifying and aligning quality measures.
The AHA also recommends developing different paths for provider participation, such as partial capitation for certain services (e.g., Medicare Part B), partial capitation for certain services (e.g., for patients with multiple chronic conditions), and full capitation for those providers that are willing and able to take on such risk.