Dr Clif Gaus Highlights Excitement and Anxiety at NAACOS Fall 2018 Meeting

Accountable care organizations (ACOs) are of 2 minds right now. On the one hand, there is a lot of excitement for the future of ACOs, but there is also great anxiety around the changes that CMS proposed for the Medicare Shared Savings Program (MSSP), said Clif Gaus, ScD, president and CEO of the National Association of ACOs (NAACOS).

What were some of the key takeaways from the NAACOS fall 2018 meeting?
I would say there are a couple, in addition to breaking our own record with attendance, and I would say the level of excitement here is as high as I’ve seen around our future, but the anxiety is probably as high as I’ve ever seen because of the proposed changes that CMS is proposed to make [to MSSP].

I’m confident, I guess, that we’ll see some give on their part, particularly around the speed that they’re asking us to move to risk, and particularly around the reduction in shared savings. I’m quoted in other places as saying, “there’s a carrot and a stick, and what they proposed to do is cut the carrot in half.” And going from 50% savings shared with the ACO to 25% is a dramatic decline and that would affect the new ACOs coming into the program in 2019 and 2020.

So, we’re hopeful they’ll both adjust that speed to risk and the shared savings amount—go back to the 50%. We see that as a minimum to engage the hospitals and doctors in what is an expensive undertaking for them. Our estimates are at least $1 million a year in infrastructure for an ACO, on average, and that includes hiring the care coordinators, that includes all the information systems, and medical systems. So, they’re not going to make that kind of investment out of their own pockets, if there’s not some hope that they’ll achieve savings and get paid back for that.
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