Dr Joe Antos: CMS' Proposed MSSP Changes Don't Account for Variability in Healthcare

The proposed CMS regulation to change the Medicare Shared Savings Program (MSSP) so that accountable care organizations (ACOs) take on risk faster creates a one-size-fits-all model that doesn’t allow for variability, said Joe Antos, PhD, the Wilson H. Taylor Resident Scholar in Health Care and Retirement Policy at the American Enterprise Institute.

How do you think pushing more accountable care organizations (ACOs) to take on risk faster will impact participation in the MSSP?

I’m concerned about the new CMS regulation, because it’s not at all clear that giving ACOs 5 years, I believe it is, and you’re either successful or you’re out, necessarily makes sense. There’s a lot of variability in healthcare. That’s the problem. And there’s a lot of variability geographically, and a whole bunch of other factors are at work as well.

So, this one-size-fits-all—which, unfortunately, is pretty much the only way the government can set a rule—makes it difficult. I think, in the end, what people have predicted will probably come true, but it might be transitory. I think there will be ACOs who are now in the program who will drop out. There will be some discouragement factor there. Not as many organizations will try to become an ACO, until the kinks are worked out. I think that’s the issue. Because it’s not just “there’s a rule.” It’s, “well, how does CMS actually implement it and are there ways to deal with whatever the hard barriers are?” These are businesses—they’ll find ways.
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