CMS Finalizes Overhaul of MSSP With Some Changes to Its Proposed Rule

December 22, 2018

CMS has finalized “Pathways to Success,” its overhaul of the Medicare Shared Savings Program (MSSP) that will push accountable care organizations to assume risk more quickly. The final rule includes some changes to the proposed rule, which was introduced in August.

CMS has finalized “Pathways to Success,” its overhaul of the Medicare Shared Savings Program, which it says is designed to advance 5 goals: accountability, competition, engagement, integrity, and quality.

The finalized rule, which will push accountable care organizations (ACOs) to assume risk more quickly, contains several changes from the proposed rule that was introduced in August.

“Pathways to Success is a bold step towards quality healthcare at a lower cost through competition and beneficiary engagement,” said CMS Administrator Seema Verma in a statement. “The rule strikes a balance between encouraging participation in the ACO program and advancing the transition to value, ultimately protecting taxpayers and patients. Medicare can no longer afford to support programs with weak incentives that do not deliver value.”

The program will replace the traditional 3 tracks with 2 new tracks called Basic and Enhanced that ACOs will enter into for an agreement period of no less than 5 years.

Under the Basic track, ACOs will start in a 1-sided model and incrementally phase in higher levels of risk, which at the highest level would qualify them as an advanced alternative payment model (APM) under the Quality Payment Program. Down from the current 6 years, new ACOs will be able to stay in 1-sided risk for 2 years and existing ACOs will be able to stay for 1 more year. In an addition to what CMS originally proposed in August, “low revenue” (physician-led) ACOs will be able to stay in 1-sided risk for 3 years.

The program will set the shared savings rate at 40% for ACOs not assuming risk, after initially proposing to cut potential shared savings in half from 50% to 25%. The shared savings rate will remain at 50% for those at all levels of risk to “strengthen the on-ramp to the program while rewarding ACOs that take on greater risk with higher shared savings rates.”

The National Association of ACOs responded to today’s announcement, saying that it appreciates CMS’ effort in the final rule to provide greater stability to the program. “We are very pleased CMS returned shared savings rates for many ACOs back to the historic precedent of 50% for some and 40% for others, increased the proposed 1-sided risk term for certain low-revenue ACOs to 3 years, and made steps forward in needed adjustment policies,” said Clif Gaus, chief executive of NAACOS, in a statement.

The program will allow ACOs to offer new incentive payments, in the form of gift cards or vouchers, to beneficiaries for taking steps to achieve good health, such as using primary care services and follow-up care. It will also expand access to telehealth.

Today’s rule requires ACOs to provide beneficiaries in an ACO with a written notice in person or via email or patient portal that they are participating in the new program.