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6 ACO Changes Included in CMS Proposed Physician Rule

Analysis  |  By Laura Beerman  
   July 08, 2022

The agency's proposed 2023 Physician Fee Schedule features expanding access to accountable care organizations (ACOs).

The National Association of Accountable Care Organizations (NAACOS) is applauding CMS' potential changes to the Medicare Shared Savings Program (MSSP). The changes, part of the federal agency's 2023 proposed Physician Fee Schedule, include the following six highlights:

  1. Allow ACOs to progress more slowly from low to high risk.
  2. Use a "prospectively projected administrative growth factor" to make ACO benchmarks more accurate and equitable.
  3. Support strong-performing ACOs with large, underserved populations via a "health equity quality adjustment."
  4. Give smaller ACOs faster access to shared savings payments to support the underserved.
  5. Prevent benchmark lowering by accounting for prior ACO savings.
  6. Update quality scoring.

CMS states that the proposed changes to MSSP, if finalized, "represent some of the most significant reforms since the final rule that established the program was finalized in November 2011 and ACOs began participating in 2012."

This would be keeping with proposed changes to other CMS ACO programs, as noted in a NAACOS press release by president and CEO Clif Gaus: "While we are still studying the major changes, policies in today's proposed Physician Fee Schedule will help grow participation in . . . [ACOs], helping realize the CMS Innovation Center's recent Strategy Refresh to have every Medicare beneficiary in a relationship with a provider accountable for his or her quality and total cost of care by 2030."

CMS' Dr. Meena Seshamani, deputy administrator and director of the Center for Medicare, noted: "Integrated coordinated, whole-person care — which addresses physical health, behavioral health, and social determinants of health — is crucial for people with Medicare, especially those with complex needs."

Seshamani added: "If finalized, the proposals in this rule will advance equity, lead to better care, support healthier populations, and drive smarter spending of the Medicare dollar."

Laura Beerman is a contributing writer for HealthLeaders.

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