Statement on CMS Changes to the Medicare Shared Savings Program in Light of the Pandemic

By Blair Childs, Senior Vice President, Public Affairs

Premier appreciates the Centers for Medicare & Medicaid Services’ release of additional details on how it will mitigate COVID-19 impact on Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) and doing so in advance of the deadline for ACOs to leave the program without financial penalty. Giving ACOs the option to maintain their current level of risk for an additional year and to extend expiring agreements is critical. This will help providers remain focused on their public health emergency response while maintaining their investments in population health. These actions align with Premier’s previous requests to the Administration,Congress and the Medicare Payment Advisory Commission aimed at maintaining the movement to value-based care.

We are, however, disappointed that new entities are unable to enter the program until January 2022. As this public health emergency has variable impacts across the country, some entities are ready and willing to enter the program. They should have that opportunity. Additionally, CMS must ensure alignment across Innovation Center programs by allowing a one-year extension for all models.

Moreover, we appreciate that, as a risk mitigation step, CMS removed COVID-19 episodes triggered by an inpatient admission from the calculation of ACO expenditures. However, it is unclear if this policy will be sufficient to mitigate exposure to losses. The regional variability in testing and changes in coding and documentation guidance may result in undercounting COVID-19 expense. We applaud CMS for considering additional approaches to mitigate the financial impact beyond the current extreme and uncontrollable circumstances policy.

In the absence of knowing when the public health emergency will conclude some ACOs may be uncomfortable with remaining in a risk-based arrangement. CMS must send a signal that down-side risk entities are valued. This can be done by providing a one-time incentive to two-sided risk ACO entities and a MACRA bonuses to all clinicians in those ACOs. We look forward to continuing to work with CMS in this regard.

Finally, we are grateful that CMS has implemented additional flexibilities that we requested, including expanded audio-only telehealth and holding hospitals harmless for decreases in graduate medical education payments that are caused by changes in bed counts or staffing during the public health emergency.