Most ACOs would flee Medicare program if pushed to take on more risk

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By: Mike Stankiewicz

A huge chunk of organizations plan to leave the Medicare Shared Savings Program if they’re forced to take on financial risk, which could slow the government’s transition to value-based care.

And it remains unclear whether the Centers for Medicare & Medicaid Services (CMS), which oversees the program, will make any sought-after changes. A recent letter from the agency, obtained by FierceHealthcare, offered a vague response to concerns about a possible drop in participation, even as another agency indicated it is reviewing proposed changes to the program.

survey released by the National Association of Accountable Care Organizations (NAACOS) found that 71% of accountable care organizations (ACOs) in non-risk-based tracks that entered the Medicare Shared Savings Program in 2012 and 2013 will leave the program if they are forced to take on financial risk.

Organizations are allowed enter two successive non-risk-based three-year contracts before being forced to enter a financial-risk track, under which they could potentially lose money. NAACOS, which says some organizations are not yet prepared to take on risk, has been pleading for the Medicare agency to allow those ACOs to enter into a third Track 1 agreement period.

“The amount of organizations that could drop out is much worse than we originally expected,” Allison Brennan, vice president of policy at NAACOS, told FierceHealthcare. “This would be detrimental to the healthcare sector’s transition to value.”

Courtesy of NAACOS

Eighty-two ACOs will face the predicament next year, totaling nearly 20% (PDF) of all organizations participating in the program in 2018. NAACOS’ survey found that 66% of those organizations would remain in the program if allowed a third Track 1 contract.

Responding to a request from the organization to permit ACOs to enter a third non-risk-based contract, CMS Administrator Seema Verma offered a vague response that did not directly address NAACOS’ concerns.

“We share your interest in the long term success of the Medicare Shared Savings Program,” Verma wrote in a letter obtained by FierceHealthcare. “Our results to date show that ACOs in performance-based risk tracks perform better than shared savings only ACOs.”

 Brennan said there is still time for the agency to act. Organizations typically need to notify
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