Medicare Compliance & Reimbursement

Plus: Register the MSSP proposal on repayment of losses.

CMS offers Accountable Care Organizations (ACOs) an electronic clinical quality measures (eCQMs) reporting olive branch in recent rulemaking, but other proposals aren’t as rosy. Read on for the details.

Backtrack: In the CY 2021 Medicare Physician Fee Schedule (MPFS) final rule, CMS admitted that ACOs had been impacted by the pandemic and suggested that extreme and uncontrollable circumstances policies would apply to the Medicare Shared Savings Program (MSSP). However, in tandem with the COVID-19 updates, CMS also solidified a new program, the Alternative Payment Model Performance Pathway (APP) in the rule.

The National Association of ACOs (NAACOS), along with other stakeholders, argued that the agency’s launch of the APP and coordinated efforts to streamline the MSSP for participating ACOs would be challenging in the middle of a worldwide public health emergency (PHE) to say the least.

“We have significant concerns about the MSSP quality policies finalized at the very end of 2020,” noted NAACOS, AMA, the American Hospital Association (AHA), and eight other industry organizations in a May 4 letter to HHS Secretary Xavier

Becerra. “The policy changes lacked adequate input from the patient, ACO, physician and hospital communities, and it is unclear how the Center for Medicare & Medicaid Services (CMS) determined that the Alternative Payment Model Performance Pathways (APP) measures are more appropriate than the current measures on which ACOs are evaluated,” the organizations said.

Now: The APP is still a go, but CMS now proposes to extend the CMS Web Interface for an additional two years for ACOs, according to the CY 2022 MPFS proposed rule, (see story, p. 1). This would allow for a “longer transition to ACO eCQM/MIPS CQM quality measure reporting, which require all-payer data,” notes the QPP 2022 fact sheet.

“We are also proposing an additional one-year freeze before the phase-in of the increase in the quality performance standard ACOs must meet to share in savings and an additional revision in the quality performance standard to encourage ACOs to report all-payer measures,” CMS says. These proposed updates would give ACOs another three years to transition to reporting “eCQMs/ MIPS CQMs under the APP and to meet the increased Shared Savings Program quality performance standard,” CMS adds.

“NAACOS over the last year has cited potential negative consequences to patient care among the many reasons why such a rapid shift to eCQM reporting was bad policy. NAACOS is pleased that the Biden Administration listened to these concerns and is taking action,” said Clif Gaus, ScD, President and CEO of NAACOS, in a July 13 statement on the proposals. “Delaying last year’s changes is the right thing to do.”

Bonus: For 2022, ACOs can still submit three eCQMs/MIPS CQMs if they want to, or they can do 10 CMS Web Interface measures.

“ACOs can also report both and receive the most favorable score,” relates Suzanne Michelle Joy with law firm Holland & Knight LLP in online analysis of the proposed rule. “In either case, ACOs must administer a CAHPS for MIPS survey and be evaluated by CMS on two claims-based measures.”

Prep for a Possible Repayment Rework in 2022

The eCQM reporting change-up isn’t the only ACO-related proposal CMS has up its sleeve. One of the agency’s key MSSP proposals involves an overhaul of its repayment methodologies for risk-driven ACOs. CMS aims to revamp the repayment strategies for risk-based ACOs, ensuring that those willing to reap the rewards also have mechanisms in place to repay their losses.

CMS wants to “revise the methodology for calculating repayment mechanism amounts for risk-based ACOs to reduce the percentage used in the existing amount by 50 percent,” the fact sheet says. “ACOs accepting performance-based risk must establish a repayment mechanism (i.e, escrow, line of credit, surety bond) to assure CMS that they can repay losses for which they may be liable upon reconciliation.”

The agency also suggests revising from the get-go thresholds that determine an ACO’s repayment schedule and cutting down repayment frequencies during the agreement period. This would lower ACOs’ participation roadblocks to two-sided models by offering resources to boost coordination, cost-saving, and quality.

Plus, “the agency would allow current ACOs to elect to decrease their amount without signing a new participation agreement,” Joy says.

CMS is looking for feedback on these policies and others that impact ACOs and the MSSP. The public can offer input at www.regulations.gov/document/CMS-2021-0119-0053 through Sept. 13.

Resource:  Find the CY 2022 MPFS proposed rule at www.govinfo.gov/content/pkg/FR-2021-07-23/pdf/2021-14973.pdf.