Stephen Nuckolls Discusses What May Change Under the Proposed Pathways to Success

While the proposed changes to the Medicare Shared Savings Program (MSSP) won’t mean a large number of changes to Coastal Carolina Quality Care, the accountable care organization will have to make some changes to respond to the new Enhanced track, said Stephen Nuckolls, CEO of Coastal Carolina Quality Care.

Coastal Carolina Quality Care has been participating in the MSSP since the beginning. What do the proposed changes mean for your ACO?
There were a number of different changes in the Pathways to Success. We are currently looking at Track 3 for next year or, under the new proposed regulations, would be called the Enhanced track. There were not a great number of changes to it. There was 1 with benchmarking, where they would allow the benchmark to go up by 3% for risk adjustment. So, we see that as a positive. While we would like for it to be more than 3%, just the acknowledgement that the population does change over time and they are allowing for some upward fluctuation, as well as downward fluctuation, in the risk scores, we see as a positive.

Has the ACO started identifying how it might need to change if the Pathways to Success regulations take effect?
With the new proposed Pathways to Success, we are considering a Track 3 ACO or Enhanced track for next year. As part of that, to get ready, we’re doing a number of things. We’re evaluating an aggregate reinsurance contract, because the risk of substantial loss to a small medical practice is big. So, we’re looking at those options. Largely, we will be using a lot of the same techniques that we’ve used in the past. It is a much greater risk, but with that risk will also come some anxiety, and maybe that will lead to greater performance. But we’ll just have to see.
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