Advanced Search

Medicare Compliance & Reimbursement

Medicare Shared Savings Program:

CMS Pushes Forward With Value-Based Care Revamp

Published on Fri Dec 02, 2022

Expect more equity-centered policies going forward.

The pandemic revealed that many of the most vulnerable patients lack access to affordable healthcare. The feds want to reverse that trend and help beneficiaries by bolstering their value-based initiatives — and that starts with some overhauls to the Medicare Shared Savings Program (MSSP) for calendar year (CY) 2023.

Context: On Nov. 18, the Centers for Medicare & Medicaid Services (CMS) published the Medicare Physician Fee Schedule (MPFS) final rule for CY 2023 in the Federal Register. Per usual, the final rule is densely packed at a hefty 1,297 pages in its published version (unpublished it was over 2,900 pages), including updates and revisions to value-based payment models. As promised, CMS followed through with its proposals to jumpstart the MSSP by creating more perks for providers and more avenues for participation for beneficiaries.

Why? Statistics show that beneficiary assignment to MSSP accountable care organizations (ACOs) has plateaued in recent years, and CMS wants to bolster its flagship value-based payment model, notes a fact sheet on the rule. “Higher spending populations are increasingly underrepresented in the program since the change to regionally-adjusted benchmarks … and access to ACOs appears inequitable,” CMS maintains. In fact, “data indicat[es] that Black (or African American), Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native beneficiaries are less likely to be assigned to a Shared Savings Program ACO than their Non-Hispanic White counterparts,” the agency warns.

Though MSSP growth has stagnated, the program has shown promise, promotes “whole-person care,” and saves money. That’s why CMS wants to continue to invest in the MSSP and align the program with other Medicare value-based and equity initiatives.

“The Medicare Shared Savings Program demonstrates how a coordinated care approach can improve quality and outcomes for people with Medicare while also reducing costs for the entire health system,” said CMS Administrator Chiquita Brooks-LaSure in a release. “Accountable Care Organizations are a true Affordable Care Act success story, and it is inspiring to see the results year after year. The Biden-Harris Administration and CMS are committed to a health care system that delivers high-quality affordable, equitable, person-centered care — and a Medicare program that can deliver just that.”

Here Are 5 Major MSSP Changes to Know

CMS decided to reimagine the MSSP for several core reasons ranging from changing quality and performance reporting and requirements to eliminating unnecessary administrative burdens. But, a key point centers on boosting ACO participation while incentivizing current providers to stay in the MSSP, says attorney Rachel E. Yount with law firm Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C. in online legal analysis. “CMS’ changes to the MSSP are designed to reverse these trends by making the MSSP more appealing to providers, particularly providers that are new to the MSSP and/or that serve underserved populations,” Yount maintains.

Here is a breakdown of five important policy updates to add to your MSSP checklist:

1. CMS cuts administrative burdens. In the final rule, CMS offers a plethora of paperwork cuts. For example, ACOs won’t need to submit their marketing materials to CMS for review or approval starting Jan. 1, the fact sheet indicates. Other burden-reducing updates include changes to beneficiary notifications; SNF 3-day rule waiver requirements; and data sharing for organized health care arrangements (OHCAs).

2. Benchmarking methodologies are significantly different. “In the final rule, CMS finalized modifications to the benchmarking methodology to reduce the impact of ACOs’ performance on their benchmarks,” explains Yount. “CMS is also revising its risk adjustment methodology to better account for medically complex, high cost populations.”

3. Sliding scale is coming back into rotation. To help with ACOs transition to all payer quality measures reporting, CMS is tweaking its reporting and performance requirements. For instance, “provisions include reinstitution of a sliding scale reflecting an ACO’s quality performance for use in determining shared savings for ACOs, regardless of how they report quality data, and to revise the approach for determining shared losses for ENHANCED track ACOs,” the fact sheet says.

4. Policies bolster equity initiatives. CMS finalized a health equity adjustment tied to an ACO’s quality performance category score. CMS “will upwardly adjust quality performance scores of ACOs that serve a minimum number of underserved or dually eligible beneficiaries,” Yount clarifies.

5. Inexperienced ACOs get a stronger transition to riskier models. CMS finalized policies to better help smaller providers in rural and underserved areas transition to two-sided risk models. ACOs with agreement periods beginning Jan. 1, 2024 that lack experience with performance-based risk can participate in a one-sided shared savings model for five years, the fact sheet says. “For performance years beginning January 1, 2023, and January 1, 2024, we are finalizing our proposal to allow ACOs currently participating in Level A or B the option to elect to continue in their current level of the BASIC track glide path for the remainder of their agreement,” CMS adds.

Stay tuned: Medicare Compliance & Reimbursement will continue to analyze the final rule and offer guidance on MSSP policies for both CY 2023 and 2024.

Resource: Check out the MPFS final rule in the Federal Register at www.govinfo.gov/content/pkg/FR-2022-11-18/ pdf/2022-23873.pdf.

Other Articles in this issue of

Medicare Compliance & Reimbursement

View All