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CMS Finalizes 2017 Changes for MSSP ACOs

News  |  By HealthLeaders Media News  
   June 07, 2016

Revisions to Medicare's most popular accountable care model include new benchmarking methodologies and incentive to adopt two-sided risk.

The Centers for Medicare & Medicaid Service released on Monday the final rule that sets 2017 regulations for the Medicare Shared Savings Program.

The agency aims to encourage more physicians join accountable care while also refining how the program measures success.

Andy Slavitt, acting administrator of CMS, said in a statement that "These new flexibilities are based on significant input from participants and will help physicians prepare for the new quality payment program, part of bipartisan legislation Congress passed last year repealing the failed Sustainable Growth Rate [formula]."

CMS provided highlights of the 2017 final rule for MSSP in a fact sheet:

  • The benchmarking methodology for national fee-for-service calculations has been revised for the first agreement period of MSSP ACOs. The new methodology will use assignable Medicare FFS beneficiaries instead of all FFS beneficiaries.
  • CMS also is revising the approach for resetting an ACO's benchmark for a second or subsequent agreement period beginning on or after January 1, 2017. This change replaces the national trend factor with regional trend factors.
  • An ACO's regional service area will include any county where one or more assigned beneficiaries live. CMS will use county-level data to determine regional FFS expenditures for the assignable beneficiary population in the ACO's regional service area.
  • In a significant step away from past MSSP benchmarking methodologies, the 2017 final rule will determine an ACO's rebased historical benchmark to reflect the ACO's performance relative to other providers in the same regional market, rather than evaluating an ACO against its own past performance.
  • To help ACOs and other stakeholders calculate risk and forecast expenditures, CMS plans to release annual data files with county-level expenditure and risk score data.
  • The 2017 final rule seeks to ease an ACO's transition from upside-only risk to two-sided risk. The 2017 final rule will allow Track 1 ACOs to take on two-sided risk but defer exposure to downside risk for one year, essentially granting a Track 1 ACO a fourth year of upside-only risk before it has exposure to two-sided risk.
  • For the first time since MSSP was launched in 2012, the 2017 final rule sets timeframes for the reopening of shared savings gains or loss payments determinations when an audit finds there has been an error in the calculation.

There are more than 430 MSSP ACOs in 49 states and the District of Columbia serving more than 7.7 million Medicare beneficiaries, according to CMS.

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