The 2019 CMS ACO Notice of Intent to Apply deadline is now less than two weeks away, when health systems and physician groups will opt into risk-based payment models. The following are our key takeaways from the new Medicare Shared Savings Program (MSSP) Pathways to Success Final Rule that ACOs and their industry partners should be aware of:
1. All ACOs will move to two-sided risk within the defined two-year runway and the performance period will move to five years from three years.
2. There will be a distinction between high-revenue/low revenue or physician-led ACOs with different participation options – per the final rule, “low-revenue” or physician-led organizations taking upside-only risk can remain in the program for up to three years (rather than two years in the proposed rule).
3. CMS will be capping risk adjustment at 3% to the ACO benchmark.
4. CMS includes adjustments to the program that expands waivers for SNF for all ACOs in downside risk and removes restrictions on geography for telehealth services and CMS is allowing for a Beneficiary Incentive Program for ACOs with downside risk.
5. The shared savings rate has changed from 25 percent to up to 40 percent for one-sided models and up to 50 percent for all two-sided models and up to 75 percent for the Enhanced track.
6. There will be a transition from national benchmarking to regional benchmarking which allows for regional trend factors when establishing and updating the benchmark during its initial agreement period.
7. CMS is providing ACOs with the option to elect prospective assignment (attribution) or preliminary prospective assignment with retrospective reconciliation prior to the start of each agreement period.