NAACOS Leaders Ask CMS Officials to Address MSSP Issues

On Sep. 9, leaders at the Washington, D.C.-based NAACOS—the National Association of ACOs—filed comments to the proposed 2025 Medicare Physician Fee Schedule, focusing on their concerns around proposed changes to the Medicare Shared Savings Program (MSSP). NAACOS is the leading national organization focused on the interests of the leaders of accountable care organizations, representing more than 400 ACOs nationwide.

In an announcement sent to the news media, NAACOS’s leaders said that “Today, the National Association of ACOs filed comments in response to the proposed 2025 Medicare Physician Fee Schedule rule, which makes several updates to the Medicare Shared Savings Program, Medicare’s largest alternative payment model. Among the favorable policies supported by NAACOS include:

•            Efforts to exclude all payments associated with CMS-identified significant, anomalous, and highly suspect (SAHS) billings from ACOs’ financial calculations

•            Allowing ACOs to elect to receive prepaid shared savings payments

•            Adding a Health Equity Benchmark Adjustment that would upwardly adjust benchmarks for ACOs

•            Creating new billing codes for Advanced Primary Care Management services

•            Creating a process by which ACOs can request CMS recalculate shared savings and losses to account for improper payments identified”

They went on to state that, “However, the proposed rule does not address two significant issues within the Medicare Shared Savings Program. This includes:

•            The lowering of ACOs’ financial benchmarks over time. Because ACO benchmarks are predominantly based on the historic spending of their patients and ACOs have generated more than $22 billion in gross savings over the past decade, ACOs’ financial spending targets are reaching unsustainable levels. NAACOS asks that CMS seek multi-stakeholder input on the overall financial goals of alternative payment models, reasonable comparison groups for defining success, and redesigning benchmarks to attract new participants and maintain current participants.

•            Challenges with the model’s quality reporting mechanisms. Specifically, CMS currently plans to sunset the predominant way in which ACOs report quality and require all ACOs to report promoting interoperability requirements beginning next year. Even by CMS’s own admission, navigating these polices will be difficult for ACOs. The result of these policies is that ACOs have and will continue to remove practices, particularly smaller and independent practices. Scores of ACOs and eight national health associations, including NAACOS, submitted a separate, detailed letter to CMS outlining recommendations for improving the quality reporting process.”