Medicare's most popular ACO program is criticized for failing to save taxpayer dollars and perpetuating a fee-for-service approach to the financing of healthcare services.
A healthcare payment reform advocate is calling on Medicare officials to shift away from agency's biggest shared savings program and to foster more alternative payment models that generate value for patients and taxpayers.
Harold D. Miller, president and CEO at the Center for Healthcare Quality and Payment Reform, a non-profit, is lambasting the new Track 1+ in the Medicare Shared Savings Program and the Centers for Medicare & Medicaid Services.
"The CMS MSSP program has been a failure. CMS has lost money on the program for three straight years from 2013 to 2015, and the annual losses tripled from 2013 to 2015, totaling $216 million in 2015. CMS is losing money because nearly half—48%—of the accountable care organizations are increasing spending and the shared savings payments it makes to the ACOs that did save money wipe out any net savings it received," Miller says.
More healthcare providers participate in MSSP than any other ACO initiative that CMS has launched. Last year, 433 healthcare provider organizations participated in the program.
Until CMS rolls out MSSP Track 1+ in 2018, there are three tracks in the program, with varying levels of financial risk and shared-savings rates. MSSP Track 1 has no downside financial risk and the lowest shared-savings rate. MSSP Track 2 and Track 3 both have downside risk and higher shared-savings rates compared to Track 1.
Last month's announcement about the creation of Track 1+ highlights key elements of the new MSSP payment model, such as the opportunity for participating ACOs to qualify for Advanced Alternative Payment Model status under the Medicare Access and CHIP Reauthorization Act (MACRA).
"The new Medicare ACO Track 1+ Model will test a payment model that incorporates more limited downside risk than is currently present in Tracks 2 or 3 of the Medicare Shared Savings Program in order to encourage more rapid progression to performance-based risk," CMS officials said in last month's announcement.
CMS is 'On the Wrong Track'
In doubling down on MSSP, CMS is on the wrong track in promoting value-based care, Miller says.
"CMS is creating Track 1+ because it has been criticized for failing to create the kinds of alternative payment models that physicians can use to meet the requirements of MACRA," he says.
"But rather than creating true alternative payment models that would actually pay physicians and hospitals differently so they can deliver better care to patients, CMS is creating another variant of the same failed ACO approach it has been using for the past five years. It has more downside risk than Track 1 and less downside risk than Tracks 2 or 3; but otherwise, it's the same program that has been failing to date."
"The primary attraction of Track 1+," says Miller, "is that it has the minimum downside risk needed to meet the CMS requirements for 'more than nominal financial risk' under MACRA, which means that physicians participating in Track 1+ would be eligible for a 5% bonus."
"So if they participate in Track 1+ in 2018, they would get a 5% bonus on their revenues in 2019 and be subject to a maximum penalty of 8% of their revenues. Even if they achieve no savings at all, they would get a 5% bonus. But an ACO should be about improving patient care, not simply creating a way for a physician to get a 5% bonus."
CMS needs to adopt alternative payment models that are truly value-based, he says, unlike MSSP, which was designed to squeeze more efficiency out of the fee-for-service business model that has dominated the financing of healthcare services in the country for decades.
"Hopefully, say Miller, "the Trump administration will recognize that the way to get higher quality, more affordable healthcare is not to shift more risk onto either physicians or patients, but to accelerate efforts to create true alternative payment models that enable physicians to deliver care to patients in different, better and lower-cost ways."
"There are many examples of physicians who have shown that they can dramatically improve quality and reduce costs if they can be paid to deliver services differently, but Medicare doesn't pay that way, and ACOs don't either. CMS needs to accelerate the process of implementing the alternative payment models that many physicians and medical societies have developed."
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Christopher Cheney is the senior clinical care editor at HealthLeaders.